Diagnostic and Prognostic Utility of CT Perfusion Imaging in Posterior Circulation Acute Ischemic Stroke: A Systematic Review and Meta‐Analysis

2021 ◽  
Author(s):  
Anubhav Katyal ◽  
Zeljka Calic ◽  
Murray Killingsworth ◽  
Sonu Bhaskar
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Perfusion Imaging ◽  
Ct Perfusion ◽  
Meta Analysis ◽  
Posterior Circulation ◽  
Ct Perfusion Imaging ◽  
Prognostic Utility

scholarly journals Diagnostic Accuracy of CT Perfusion Imaging for Detecting Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

2013 ◽  
Vol 35 (6) ◽  
pp. 493-501 ◽  
Author(s):  
J.M. Biesbroek ◽  
J.M. Niesten ◽  
J.W. Dankbaar ◽  
G.J. Biessels ◽  
B.K. Velthuis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Diagnostic Accuracy ◽  
Acute Ischemic Stroke ◽  
Perfusion Imaging ◽  
Ct Perfusion ◽  
Meta Analysis ◽  
Ct Perfusion Imaging

Automated CT perfusion imaging for acute ischemic stroke

Neurology ◽  
2019 ◽  
pp. 10.1212/WNL.0000000000008481 ◽  
Author(s):  
Achala Vagal ◽  
Max Wintermark ◽  
Kambiz Nael ◽  
Andrew Bivard ◽  
Mark Parsons ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Perfusion Imaging ◽  
Ct Perfusion ◽  
Ct Perfusion Imaging

scholarly journals Dynamic CT Perfusion Imaging for the Detection of Crossed Cerebellar Diaschisis in Acute Ischemic Stroke

2012 ◽  
Vol 13 (1) ◽  
pp. 12 ◽  
Author(s):  
Young Wook Jeon ◽  
Seo Hyun Kim ◽  
Ji Yong Lee ◽  
Kum Whang ◽  
Myung Soon Kim ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Perfusion Imaging ◽  
Ct Perfusion ◽  
Dynamic Ct ◽  
Crossed Cerebellar Diaschisis ◽  
Ct Perfusion Imaging ◽  
Cerebellar Diaschisis

Abstract T MP4: Quality of CT Perfusion Imaging Thresholds for Infarct and Penumbra in the Acute Ischemic Stroke Setting: An Updated Systematic Review

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Christopher d'Esterre ◽  
Jonathan Dykeman ◽  
Mohamed Al-mekhlafi ◽  
Petra Cimflova ◽  
Shivanand Patil ◽  
...  
Keyword(s):  
Systematic Review ◽  
At Risk ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Perfusion Imaging ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Mean Transit Time ◽  
Infarct Core ◽  
Not At Risk

Background: CT Perfusion (CTP) may inform treatment decisions in acute ischemic stroke (AIS). We sought to determine extent of variability with CTP thresholds for infarct core and penumbra and reasons for such variability using an up-to-date systematic review. Methods: Search strategy combined the themes of AIS, perfusion imaging, and CT/MRI. Two independent reviewers screened at all levels; disagreements were settled through consensus. Inclusion criteria were CTP within 24hrs of stroke onset and reported perfusion thresholds for infarct core, penumbra, and/or normal/not at risk tissue for mixed grey/white matter. Study demographics, QUADAS assessment of quality, and mean thresholds of cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), relative CBV (rCBV), relative CBF (rCBF), and relative MTT (rMTT) were collected. Thresholds were reported as median mean threshold (interquartile range). Results: The search resulted in a total of 11919 abstracts from EMBASE and MEDLINE. Of these, 711 studies were identified for full-text review, 134 met all eligibility criteria. 29 studies provided thresholds for CTP and were included in the review. For CBF, median mean threshold was 8.64 (7.94-13.92) ml/min/100g for core, 19.1 (17.1-31.9) ml/min/100g for penumbra and 47.4 (35.6-59.1) ml/min/100g for normal/not at risk tissue. For CBV, median mean threshold was 1.0 (0.68-1.88) ml/100g for core, 2.45 (2.0-3.0) ml/100g for penumbra, and 2.65 (2.0-3.3) ml/100g for normal/not at risk tissue. For MTT median mean threshold was 15.6 (15.3-17.7) seconds for core, 10.5 (7.1-46.2) seconds for penumbra, and 3.9 (3.65-4.15) seconds for normal/not at risk tissue. Median mean threshold for rCBF was 29% (22.5%-35.5%) for core. Sufficient TTP and Tmax data were not reported. Overall, quality was highly variable according QUADAS ranging from 20.7% to 93.1% across the 14 variables. Conclusions: Due to heterogeneity of vendor CTP algorithms, follow-up imaging to define infarct core (NCCT, DWI), unknown recanalization times/reperfusion status and differing onset to CT times, CTP thresholds for infarct core and penumbra are highly variable. As such, a single best threshold for core could not be derived from literature.

scholarly journals Value of pre-intervention CT perfusion imaging in acute ischemic stroke prognosis

2021 ◽  
Author(s):  
Anubhav Katyal ◽  
◽  
Sonu Menachem Maimonides Bhaskar ◽  
◽  
◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Perfusion Imaging ◽  
Ct Perfusion ◽  
Ct Perfusion Imaging

Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

2019 ◽  
Vol 24 (5) ◽  
pp. 558-571 ◽  
Author(s):  
Kartik Bhatia ◽  
Hans Kortman ◽  
Christopher Blair ◽  
Geoffrey Parker ◽  
David Brunacci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

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