Open AccessJournal Article
First-pass quantitative CT perfusion identifies thresholds for salvageable penumbra in acute stroke patients treated with intra-arterial therapy
Pamela W. Schaefer,Luca Roccatagliata,Carlos J. Ledezma,Brian L. Hoh,Lee H. Schwamm,Walter J. Koroshetz,R. G. Gonzalez,Michael H. Lev +7 more
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TLDR
In acute stroke patients, quantitative CTP can distinguish ischemic tissue likely to infarct from that likely to survive.Abstract:
BACKGROUND AND PURPOSE: The purpose of this study was to determine whether, in acute stroke patients treated with intra-arterial (IA) recanalization therapy, CT perfusion (CTP) can distinguish ischemic brain tissue destined to infarct from that which will survive. METHODS: Dynamic CTP was obtained in 14 patients within 8 hours of stroke onset, before IA therapy. Initial quantitative cerebral blood volume (CBV) and flow (CBF) values were visually segmented and normalized in the “infarct core” (region 1: reduced CBV and CBF, infarction on follow-up), “penumbra that infarcts” (region 2: normal CBV, reduced CBF, infarction on follow-up), and “penumbra that recovers” (region 3: normal CBV, reduced CBF, normal on follow-up). Normalization was accomplished by dividing the ischemic region of interest value by that of a corresponding, contralateral, uninvolved region, which resulted in CBV and CBF “ratios.” Separate CBV and CBF values were obtained in gray matter (GM) and white matter (WM). RESULTS: Mean CBF ratios for regions 1, 2, and 3 were 0.19 ± 0.06, 0.34 ± 0.06, and 0.46 ± 0.09, respectively (all P P 0.44 infarcted. GM versus WM CBF and CBV values were significantly different for region 2 compared with region 3 ( P CONCLUSIONS: In acute stroke patients, quantitative CTP can distinguish ischemic tissue likely to infarct from that likely to survive.read more
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Guidelines for the Early Management of Patients With Acute Ischemic Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
William J. Powers,Alejandro A. Rabinstein,Teri Ackerson,Opeolu Adeoye,Nicholas C. Bambakidis,Kyra J. Becker,José Biller,Michael D. Brown,Bart M. Demaerschalk,Brian L. Hoh,Edward C. Jauch,Chelsea S. Kidwell,Thabele M Leslie-Mazwi,Bruce Ovbiagele,Phillip A. Scott,Kevin N. Sheth,Andrew M. Southerland,Deborah V. Summers,David L. Tirschwell +18 more
TL;DR: These guidelines supersede the prior 2007 guidelines and 2009 updates and support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit.
Journal ArticleDOI
Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.
William J. Powers,Alejandro A. Rabinstein,Teri Ackerson,Opeolu Adeoye,Nicholas C. Bambakidis,Kyra J. Becker,José Biller,Michael D. Brown,Bart M. Demaerschalk,Brian L. Hoh,Edward C. Jauch,Chelsea S. Kidwell,Thabele M Leslie-Mazwi,Bruce Ovbiagele,Phillip A. Scott,Kevin N. Sheth,Andrew M. Southerland,Deborah V. Summers,David L. Tirschwell +18 more
TL;DR: These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks.
Journal ArticleDOI
CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct.
I.Y.L. Tan,Andrew M. Demchuk,Julia Hopyan,Liying Zhang,David J. Gladstone,Kelvin K. L. Wong,M. Martin,Sean P. Symons,Allan J. Fox,Richard I. Aviv +9 more
TL;DR: In this article, a novel clot burden score (CBS) and collateral score (CS) were proposed to predict clinical and radiologic outcomes in patients with anterior circulation infarct presenting within 3 hours of stroke onset.
ORIGINAL RESEARCH CT Angiography Clot Burden Score and Collateral Score: Correlation with Clinical and Radiologic Outcomes in Acute Middle Cerebral Artery Infarct
TL;DR: Patients with higher CBS and CS demonstrated smaller pretreatment perfusion defects and final infarct volume and better clinical outcome and independently predicted favorable outcome.
Journal ArticleDOI
Recommendations for imaging of acute ischemic stroke: A scientific statement from the American Heart Association
Richard E. Latchaw,Mark J. Alberts,Michael H. Lev,John J. Connors,Robert E. Harbaugh,Randall T. Higashida,Robert W. Hobson,Chelsea S. Kidwell,Walter J. Koroshetz,Vincent P. Mathews,Pablo Villablanca,Steven Warach,Beverly C. Walters +12 more
TL;DR: Progress for treating acute ischemic stroke has been slow, yet the goals for treating this common disease have expanded, and there is the need to extend the therapeutic window from 3 to ≥6 hours.
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TL;DR: Recent evidence indicates that immediate failure of basic functions such as synaptic transmission, ion pumping and energy metabolism in the ischemic brain, is critically dependent on residual blood flow, and that these functions fail at certain critical flow thresholds.
Journal ArticleDOI
Guidelines for the Early Management of Patients With Ischemic Stroke A Scientific Statement From the Stroke Council of the American Stroke Association
Harold P. Adams,Robert J. Adams,Thomas G. Brott,Gregory J. del Zoppo,Anthony J. Furlan,Larry B. Goldstein,Robert L. Grubb,Randall T. Higashida,Chelsea S. Kidwell,Thomas Kwiatkowski,John R. Marler,George J. Hademenos +11 more
TL;DR: In this article, the authors provide updated recommendations that can be used by primary care physicians, emergency medicine physicians, neurologists, and other physicians who provide acute stroke care from admission to an emergency department through the first 24 to 48 hours of hospitalization by addressing the diagnosis and emergent treatment of the acute ischemic stroke in addition to the management of its acute and subacute neurological and medical complications.
Journal ArticleDOI
Thresholds of focal cerebral ischemia in awake monkeys
Thomas H. Jones,Richard Morawetz,Robert M. Crowell,Frank W. Marcoux,Stuart J. FitzGibbon,Umberto DeGirolami,Robert G. Ojemann +6 more
TL;DR: Some cases of acute hemiplegia, with blood flow in the paralysis range, might be improved by surgical revascularization, and studies of local CBF might help identify suitable cases for emergency revascularized.
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