Identification of Penumbra and Infarct in Acute Ischemic Stroke Using Computed Tomography Perfusion-Derived Blood Flow and Blood Volume Measurements
B.D. Murphy,Allan J. Fox,Donald H. Lee,Demetrios J. Sahlas,Sandra E. Black,M.J. Hogan,Shelagh B. Coutts,Andrew M. Demchuk,Mayank Goyal,Richard I. Aviv,Sean P. Symons,Irene Gulka,Vadim Beletsky,David M. Pelz,Vladimir Hachinski,Richard Chan,Ting-Yim Lee +16 more
Reads0
Chats0
TLDR
It is shown in a limited sample of patients that CBF and CBV obtained from CTP can be sensitive and specific for infarction and should be investigated further in a prospective trial to assess their utility for differentiating between infarct and penumbra.Abstract:
Background and Purpose— We investigated whether computed tomography (CT) perfusion–derived cerebral blood flow (CBF) and cerebral blood volume (CBV) could be used to differentiate between penumbra and infarcted gray matter in a limited, exploratory sample of acute stroke patients. Methods— Thirty patients underwent a noncontrast CT (NCCT), CT angiography (CTA), and CT perfusion (CTP) scan within 7 hours of stroke onset, NCCT and CTA at 24 hours, and NCCT at 5 to 7 days. Twenty-five patients met the criteria for inclusion and were subsequently divided into 2 groups: those with recanalization at 24 hours (n=16) and those without (n=9). Penumbra was operationally defined as tissue with an admission CBF <25 mL · 100 g−1 · min−1 that was not infarcted on the 5- to 7-day NCCT. Logistic regression was applied to differentiate between infarct and penumbra data points. Results— For recanalized patients, CBF was significantly lower (P<0.05) for infarct (13.3±3.75 mL · 100 g−1 · min−1) than penumbra (25.0±3.82 mL · ...read more
Citations
More filters
Journal ArticleDOI
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
Cerebral Blood Flow Is the Optimal CT Perfusion Parameter for Assessing Infarct Core
Bruce C.V. Campbell,Soren Christensen,Christopher R Levi,Patricia Desmond,Geoffrey A. Donnan,Stephen M. Davis,Mark W Parsons +6 more
TL;DR: In contrast to previous reports, CBF corresponded with the acute diffusion-weighted imaging lesion better than CBV, although no single threshold avoids detection of false-positive regions in unaffected white matter, which relates to low signal-to-noise ratio in CTP maps and emphasizes the need for optimized acquisition and postprocessing.
References
More filters
Journal ArticleDOI
Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group.
James C. Grotta,M Kothari,K.M.A. Welch,Joseph P. Broderick,Barbara C. Tilley,Thomas G. Brott,Marler,Patrick D. Lyden,Paul M. O'Byrne +8 more
Journal ArticleDOI
Intravenous Thrombolysis With Recombinant Tissue Plasminogen Activator for Acute Hemispheric Stroke: The European Cooperative Acute Stroke Study (ECASS)
Werner Hacke,Markku Kaste,Cesare Fieschi,Danilo Toni,Emmanuel Lesaffre,von Kummer R,Gudrun Boysen,Erich Bluhmki,Höxter G,Mahagne Mh +9 more
TL;DR: Intravenous thrombolysis in acute ischemic stroke is effective in improving some functional measures and neurologic outcome in a defined subgroup of stroke patients with moderate to severe neurologic deficit and without extended infarct signs on the initial CT scan, however, the identification of this subgroup is difficult.
Journal ArticleDOI
Intra-arterial Prourokinase for Acute Ischemic Stroke: The PROACT II Study: A Randomized Controlled Trial
Anthony J. Furlan,Randall T. Higashida,Lawrence R. Wechsler,Michael Gent,Howard A. Rowley,Carlos S. Kase,Michael S. Pessin,Arvind Ahuja,Fred Callahan,Wayne M. Clark,Frank L. Silver,Frank Rivera +11 more
TL;DR: Despite an increased frequency of early symptomatic intracranial hemorrhage, treatment with IA r-proUK within 6 hours of the onset of acute ischemic stroke caused by MCA occlusion significantly improved clinical outcome at 90 days.
Journal ArticleDOI
Thresholds in cerebral ischemia - the ischemic penumbra.
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
Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials
Werner Hacke,Geoffrey A. Donnan,Cesare Fieschi,Markku Kaste,Rüdiger von Kummer,Joseph P. Broderick,Thomas G. Brott,Michael Frankel,James C. Grotta,E. Clarke Haley,Thomas Kwiatkowski,Steven R. Levine,Chris Lewandowski,Mei Lu,Patrick D. Lyden,John R. Marler,Suresh C. Patel,Barbara C. Tilley,Gregory W. Albers,Erich Bluhmki,Manfred Wilhelm,Scott Hamilton,Atlantis Trials Investigators,Ecass Trials Investigators +23 more
TL;DR: The sooner that rt-PA is given to stroke patients, the greater the benefit, especially if started within 90 min, which suggests a potential benefit beyond 3 h, but this potential might come with some risks.
Related Papers (5)
Perfusion-CT Assessment of Infarct Core and Penumbra Receiver Operating Characteristic Curve Analysis in 130 Patients Suspected of Acute Hemispheric Stroke
Max Wintermark,Adam E. Flanders,Birgitta K. Velthuis,Reto Meuli,Maarten S. van Leeuwen,Dorit Goldsher,Carissa Pineda,Joaquín Serena,Irene C. van der Schaaf,A. Waaijer,James C. Anderson,Gary M. Nesbit,Igal Gabriely,Victoria Medina,Ana Quiles,Scott Pohlman,Scott Pohlman,Marcel Quist,Pierre Schnyder,Julien Bogousslavsky,William P. Dillon,Salvador Pedraza,Salvador Pedraza +22 more