Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Friday, December 3, 2021

Systematic CT perfusion acquisition in acute stroke increases vascular occlusion detection and thrombectomy rates

What the fuck good does this do if you are not even measuring 100% recovery? You do realize the only goal in stroke is 100% recovery? If not get the hell out of stroke.

 With no measurements of 100% recovery they obviously have no intention of solving stroke at all.

Business 101: If you don't measure it it is not important, so obviously 100% recovery is not important. 

“What's measured, improves.” So said management legend and author Peter F. Drucker 

Systematic CT perfusion acquisition in acute stroke increases vascular occlusion detection and thrombectomy rates

  1. Marta Olive-Gadea1,2,
  2. Manuel Requena1,3,
  3. Facundo Diaz4,
  4. Sandra Boned1,
  5. Alvaro Garcia-Tornel1,
  6. Marian Muchada1,
  7. Matias Deck1,
  8. Prudencio Lozano1,
  9. Noelia Rodriguez-Villatoro1,
  10. Jesus Juega1,
  11. Jorge Pagola1,
  12. David Rodriguez-Luna1,
  13. Marta Rubiera1,
  14. Cristian Marti4,
  15. Carlos A Molina1,
  16. Carlos Piñana3,
  17. David Hernandez3,
  18. Alejandro Tomasello3,
  19. Marc Ribo1,2
  1. Correspondence to Dr Marc Ribo, Stroke Unit, Neurology, Vall d'Hebron Hospital Universitari, Barcelona 08035, Spain; marcriboj@hotmail.com

Abstract

Background In patients with stroke, current guidelines recommend non-invasive vascular imaging to identify intracranial vessel occlusions (VO) that may benefit from endovascular treatment (EVT). However, VO can be missed in CT angiography (CTA) readings. We aim to evaluate the impact of consistently including CT perfusion (CTP) in admission stroke imaging protocols.

Methods From April to October 2020 all patients admitted with a suspected acute ischemic stroke underwent urgent non-contrast CT, CTA and CTP and were treated accordingly. Hypoperfusion areas defined by time-to-maximum of the tissue residue function (Tmax) >6 s, congruent with the clinical symptoms and a vascular territory, were considered VO (CTP-VO). In addition, two experienced neuroradiologists blinded to CTP but not to clinical symptoms retrospectively evaluated non-contrast CT and CTA to identify intracranial VO (CTA-VO).

Results Of the 338 patients included in the analysis, 157 (46.5%) presented with CTP-VO (median Tmax >6s: 73 (29–127) mL). CTA-VO was identified in 83 (24.5%) of the cases. Overall CTA-VO sensitivity for the detection of CTP-VO was 50.3% and specificity was 97.8%. Higher hypoperfusion volume was associated with increased CTA-VO detection (OR 1.03; 95% CI 1.02 to 1.04). EVT was performed in 103 patients (30.5%; Tmax >6s: 102 (63–160) mL), representing 65.6% of all CTP-VO. Overall CTA-VO sensitivity for the detection of EVT-VO was 69.9% and specificity was 95.3%. Among patients who received EVT, the rate of false negative CTA-VO was 30.1% (Tmax >6s: 69 (46–99.5) mL).

Conclusion Systematically including CTP in acute stroke admission imaging protocols may increase the diagnosis of VO and rate of EVT.

Data availability statement

Data are available upon reasonable request. Not applicable.

http://dx.doi.org/10.1136/neurintsurg-2021-018241

 
 
 
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