Utility of CT perfusion scanning in patient selection for acute stroke intervention: experience at University at Buffalo Neurosurgery–Millard Fillmore Gates Circle Hospital

2011 ◽  
Vol 30 (6) ◽  
pp. E4 ◽  
Author(s):  
Peter T. Kan ◽  
Kenneth V. Snyder ◽  
Parham Yashar ◽  
Adnan H. Siddiqui ◽  
L. Nelson Hopkins ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Patient Selection ◽  
Ct Perfusion ◽  
Brain Parenchyma ◽  
National Institutes Of Health ◽  
Time Interval ◽  
Case Examples ◽  
Flow Parameters ◽  
Selection For ◽  
The Brain

Computed tomography perfusion scanning generates physiological flow parameters of the brain parenchyma, allowing differentiation of ischemic penumbra and core infarct. Perfusion maps, along with the National Institutes of Health Stroke Scale score, are used as the bases for endovascular stroke intervention at the authors' institute, regardless of the time interval from stroke onset. With case examples, the authors illustrate their perfusion-based imaging guidelines in patient selection for endovascular treatment in the setting of acute stroke.

Abstract TP13: CT Perfusion-Guided Patient Selection for Acute Stroke Intervention Reduces In-Hospital Mortality

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Nohra Chalouhi ◽  
George Ghobrial ◽  
Stavropoula Tjoumakaris ◽  
Aaron S Dumont ◽  
L Fernando Gonzalez ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Acute Stroke ◽  
Patient Selection ◽  
Ct Perfusion ◽  
Multivariable Analysis ◽  
Group Versus ◽  
Multivariable Logistic Regression Analysis ◽  
Time Interval ◽  
Mechanical Recanalization ◽  
Perfusion Studies

Background and Purpose: Perfusion studies are increasingly used to triage acute stroke patients for endovascular recanalization therapies. However, the potential benefit of such an approach remains unproven. We compared the safety and efficacy of computed-tomography-perfusion-(CTP)-guided to time-guided mechanical recanalization in acute ischemic stroke (AIS) patients. Methods: A comparative analysis was conducted on 132 patients, 94 undergoing CTP-guided and 38 undergoing time-guided (maximum 8 hours from symptom onset) mechanical recanalization at our institution. The rates of recanalization, intracranial hemorrhage (ICH), in-hospital mortality, and overall clinical outcomes were compared. A multivariable logistic regression analysis was carried out to determine predictors of in-hospital mortality. Results: The two groups were comparable with respect to baseline characteristics with the exception of longer mean time interval from stroke onset to endovascular intervention in the CTP group (7.2 vs. 4.3 hours, p=0.006). The rate of partial-to-complete recanalization did not differ between the CTP and the non-CTP group (78.7% vs. 81.6%, respectively, p=0.71). Symptomatic and overall ICH occurred respectively in 8.5% and 18.1% in the CTP group versus 15.8% and 31.6% in the non-CTP group (p=0.06). The overall in-hospital mortality rate was significantly lower in the CTP group (15.9% vs. 36.8%, p=0.040). Likewise, mean modified Rankin Scale at discharge was 3.8 in the CTP group versus 4.4 in the non-CTP group (p=0.042). In multivariable analysis, CTP-based patient selection was an independent negative predictor of in-hospital mortality (OR= 3.2; 95% CI, 1.2-8.2; p=0.01). Conclusions: CTP-based patient selection was associated with lower ICH and mortality rates, with better overall patient outcomes. Our results suggest a significant benefit with CTP-guided patient selection and support the implementation of CTP-based protocols for triage of AIS patients for recanalization therapies.

scholarly journals CT perfusion-guided patient selection for endovascular recanalization in acute ischemic stroke: a multicenter study

2012 ◽  
Vol 5 (6) ◽  
pp. 523-527 ◽  
Author(s):  
Aquilla S Turk ◽  
Jordan Asher Magarick ◽  
Don Frei ◽  
Kyle Michael Fargen ◽  
Imran Chaudry ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Patient Selection ◽  
Multicenter Study ◽  
Ct Perfusion ◽  
Endovascular Recanalization ◽  
Selection For

Intravenous Thrombolytic Therapy in Acute Stroke

1997 ◽  
Vol 2 (1) ◽  
pp. 51-60 ◽  
Author(s):  
David C Tong ◽  
Midori A Yenari ◽  
Greg W Albers
Keyword(s):  
Thrombolytic Therapy ◽  
Acute Stroke ◽  
Patient Selection ◽  
Treatment Strategies ◽  
Recombinant Tissue Plasminogen Activator ◽  
Selection For ◽  
Clinically Significant ◽  
Patient Selection Criteria ◽  
Ct Brain ◽  
Clinical Trails

The article reviews the experimental basis of thrombolytic therapy, and summarizes the results of the recent trials of thrombolysis. Five large clinical trails have evaluated intravenous thrombolytic therapy for the treatment of hyperacute (< 6 h) stroke. Three of these studies were negative, one was equivocal, and one was strongly positive. The failure to demonstrate efficacy definitively in four of these trials may be related to a number of methodological factors, including the type and dose of drug administered, the timing of drug administered, and the method of patient selection for treatment. The NINDS recombinant tissue plasminogen activator (rt-PA) study showed that thrombolytic therapy can be of substantial benefit when administered within 3 h of stroke onset using strict patient selection criteria and rt-PA is now FDA approved for treatment of acute stroke. However, the risk of clinically significant bleeding is elevated. To achieve the favorable risk/benefit ratio demonstrated in the NINDS trial, patients must be screened by experienced clinicians for contraindications to thrombolysis and the acute computerized tomography (CT) brain scan must be carefully, evaluated for radiographic features that increase the risk of cerebral hemorrhage. Guidelines for the use of rt-PA are provided, as well as insights into future thrombolytic treatment strategies.

scholarly journals CT perfusion-guided patient selection for endovascular treatment of acute ischemic stroke is safe and effective

2011 ◽  
Vol 4 (4) ◽  
pp. 261-265 ◽  
Author(s):  
Aquilla Turk ◽  
Jordan Asher Magarik ◽  
Imran Chaudry ◽  
Raymond D Turner ◽  
Joyce Nicholas ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Patient Selection ◽  
Ct Perfusion ◽  
Selection For

Utilization of CT perfusion patient selection for mechanical thrombectomy irrespective of time: a comparison of functional outcomes and complications

2012 ◽  
Vol 5 (6) ◽  
pp. 518-522 ◽  
Author(s):  
Aquilla S Turk ◽  
Eric MacKenzie Nyberg ◽  
M Imran Chaudry ◽  
Raymond D Turner ◽  
Jordan Asher Magarik ◽  
...  
Keyword(s):  
Patient Selection ◽  
Functional Outcomes ◽  
Mechanical Thrombectomy ◽  
Ct Perfusion ◽  
Selection For
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