So you described something, WHAT THE HELL USE IS IT OF GETTING 100% RECOVERED?
CT Perfusion Ischaemic Core Measures Linked to Endovascular Outcome After Stroke
By Nancy Melville
YORK, Me -- March 18, 2021 -- Measures of ischaemic core volume detected on computed tomography perfusion (CTP) are significantly associated with outcomes following endovascular treatment of ischaemic stroke, according to a study presented at the 2021 Virtual International Stroke Conference (ISC).
“We found that larger CTP ischaemic core volume was associated with an increased likelihood of achieving poor outcome in current clinical practice,” said Jan W. Hoving, MD, Amsterdam UMC, Amsterdam, the Netherlands.
Emergency endovascular treatment of ischaemic strokes can provide improved outcomes and reduced disability following the stroke when provided up to 24 hours after stroke onset; however, a significant proportion of patients have poor outcomes and mortality, despite the treatment, within 3 months of the stroke.
Imaging techniques that can benefit decision-making for treatment selection among those patients include CTP measures of ischemic core volume, non-contrast CT for scoring of Alberta stroke program early CT score (ASPECTS), and CT angiography to determine the collateral status or assess the occlusion location.
For the current study, the researchers evaluated data from 201 patients who were enrolled in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), and who had received CTP between July 2016 and November 2017.
The patients had a baseline median National Institutes of Health Stroke Scale (NIHSS) score of 16 (interquartile range [IQR], 12-20), and their characteristics were similar to those in the overall MR CLEAN cohort.
The median CTP-calculated ischaemic core volume among the patients was 13.3 (IQR, 5.3-40.9) mL, and their median onset-to-groin time was 153 minutes. Successful reperfusion was achieved in 71% of patients, while 19% of patients were deceased at 90 days.
After adjustment for variables including age, sex, NIHSS, prestrike modified Rankin Scale (mRS), intravenous alteplase, onset-to-groin time, and occlusion site, the median CTP ischaemic core volume was associated with a poor outcome, defined as a 90-day modified Rankin Scale (mRS) score of 5 to 6 (adjusted odds ratio [aOR] = 1.03 per 10 mL; P = .004).
Median CTP ischaemic core volume was associated with good outcomes, defined as an mRS score of 0 to 2 (aOR = 0.98; P = .01). The ischaemic core volume was also associated with a shift on the mRS towards an improved outcome, defined as a shift of ≥1 point (aOR = 0.83 per 10 mL; P< .001).
The ASPECTS and CTA collateral scores were meanwhile not significantly associated with any of the 3 outcomes.
“The findings show that with increasing CTP ischaemic core volumes, the probability of achieving poor outcomes also increases,” said Dr. Hoving. “Moreover, we could not establish a statistically significant association between ASPECTS or CTA collateral score and poor outcome. CTP ischaemic core volume can play a role in identifying patients who are likely to have good outcomes after endovascular therapy.”
ISC is sponsored by the American Heart Association and the American Stroke Association.
[Presentation title: CT Perfusion-Guided Patient Selection for Endovascular Treatment of Acute Ischemic Stroke: Results From the MR CLEAN Registry. Abstract LB14]
YORK, Me -- March 18, 2021 -- Measures of ischaemic core volume detected on computed tomography perfusion (CTP) are significantly associated with outcomes following endovascular treatment of ischaemic stroke, according to a study presented at the 2021 Virtual International Stroke Conference (ISC).
“We found that larger CTP ischaemic core volume was associated with an increased likelihood of achieving poor outcome in current clinical practice,” said Jan W. Hoving, MD, Amsterdam UMC, Amsterdam, the Netherlands.
Emergency endovascular treatment of ischaemic strokes can provide improved outcomes and reduced disability following the stroke when provided up to 24 hours after stroke onset; however, a significant proportion of patients have poor outcomes and mortality, despite the treatment, within 3 months of the stroke.
Imaging techniques that can benefit decision-making for treatment selection among those patients include CTP measures of ischemic core volume, non-contrast CT for scoring of Alberta stroke program early CT score (ASPECTS), and CT angiography to determine the collateral status or assess the occlusion location.
For the current study, the researchers evaluated data from 201 patients who were enrolled in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), and who had received CTP between July 2016 and November 2017.
The patients had a baseline median National Institutes of Health Stroke Scale (NIHSS) score of 16 (interquartile range [IQR], 12-20), and their characteristics were similar to those in the overall MR CLEAN cohort.
The median CTP-calculated ischaemic core volume among the patients was 13.3 (IQR, 5.3-40.9) mL, and their median onset-to-groin time was 153 minutes. Successful reperfusion was achieved in 71% of patients, while 19% of patients were deceased at 90 days.
After adjustment for variables including age, sex, NIHSS, prestrike modified Rankin Scale (mRS), intravenous alteplase, onset-to-groin time, and occlusion site, the median CTP ischaemic core volume was associated with a poor outcome, defined as a 90-day modified Rankin Scale (mRS) score of 5 to 6 (adjusted odds ratio [aOR] = 1.03 per 10 mL; P = .004).
Median CTP ischaemic core volume was associated with good outcomes, defined as an mRS score of 0 to 2 (aOR = 0.98; P = .01). The ischaemic core volume was also associated with a shift on the mRS towards an improved outcome, defined as a shift of ≥1 point (aOR = 0.83 per 10 mL; P< .001).
The ASPECTS and CTA collateral scores were meanwhile not significantly associated with any of the 3 outcomes.
“The findings show that with increasing CTP ischaemic core volumes, the probability of achieving poor outcomes also increases,” said Dr. Hoving. “Moreover, we could not establish a statistically significant association between ASPECTS or CTA collateral score and poor outcome. CTP ischaemic core volume can play a role in identifying patients who are likely to have good outcomes after endovascular therapy.”
ISC is sponsored by the American Heart Association and the American Stroke Association.
[Presentation title: CT Perfusion-Guided Patient Selection for Endovascular Treatment of Acute Ischemic Stroke: Results From the MR CLEAN Registry. Abstract LB14]
No comments:
Post a Comment