A Novel Fast CT Perfusion Core-Penumbra Mismatch Score: Correlation With Stroke Outcome.


Journal

The neurologist
ISSN: 2331-2637
Titre abrégé: Neurologist
Pays: United States
ID NLM: 9503763

Informations de publication

Date de publication:
04 Mar 2021
Historique:
entrez: 1 3 2021
pubmed: 2 3 2021
medline: 29 10 2021
Statut: epublish

Résumé

Advanced neuroimaging can identify patients who can most benefit from reperfusion treatment, discriminating between ischemic core and penumbra area in a quick and accurate manner. Despite core-penumbra mismatch being an independent prognostic factor, computed tomography perfusion (CTP) assessment is still debated in hyperacute decision-making. The authors aimed to study a novel CTP mismatch score in emergency settings and to investigate its relation with clinical outcome in acute ischemic stroke patients treated with intravenous thrombolysis (IVT). Neuroimaging and clinical data of 226 consecutive acute ischemic stroke patients were analyzed. The study population was divided into 5 different CTP scores: (0) without perfusion deficit, (1) only penumbra, (2) penumbra > core, (3) core ≥ penumbra, (4) only core. For differences in outcome between treated and nontreated patients, and among CTP core-penumbra groups to be assessed, the authors have evaluated the outcome in terms of National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) at discharge and symptomatic intracerebral hemorrhage. A decrease in NIHSS was statistically greater in IVT-treated patients compared to nontreated patients showing only penumbra (ΔNIHSS%: 80.0% vs. 50.0%; P=0.0023) or no perfusion deficit (ΔNIHSS%: 89.4% vs. 61.5%; P=0.027) on CTP maps. The same trend was found in other groups without significant difference. A significant correlation was found in IVT patients between core/penumbra score and outcome in terms of ΔNIHSS (Kendall τ=-0.19; P=0.004). The authors proposed a novel immediate CTP assessment to score perfusion mismatch in emergency settings to guide clinicians' decision-making for aggressive treatment and to prevent stroke-related disability.

Sections du résumé

BACKGROUND BACKGROUND
Advanced neuroimaging can identify patients who can most benefit from reperfusion treatment, discriminating between ischemic core and penumbra area in a quick and accurate manner. Despite core-penumbra mismatch being an independent prognostic factor, computed tomography perfusion (CTP) assessment is still debated in hyperacute decision-making. The authors aimed to study a novel CTP mismatch score in emergency settings and to investigate its relation with clinical outcome in acute ischemic stroke patients treated with intravenous thrombolysis (IVT).
METHODS METHODS
Neuroimaging and clinical data of 226 consecutive acute ischemic stroke patients were analyzed. The study population was divided into 5 different CTP scores: (0) without perfusion deficit, (1) only penumbra, (2) penumbra > core, (3) core ≥ penumbra, (4) only core. For differences in outcome between treated and nontreated patients, and among CTP core-penumbra groups to be assessed, the authors have evaluated the outcome in terms of National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) at discharge and symptomatic intracerebral hemorrhage.
RESULTS RESULTS
A decrease in NIHSS was statistically greater in IVT-treated patients compared to nontreated patients showing only penumbra (ΔNIHSS%: 80.0% vs. 50.0%; P=0.0023) or no perfusion deficit (ΔNIHSS%: 89.4% vs. 61.5%; P=0.027) on CTP maps. The same trend was found in other groups without significant difference. A significant correlation was found in IVT patients between core/penumbra score and outcome in terms of ΔNIHSS (Kendall τ=-0.19; P=0.004).
CONCLUSIONS CONCLUSIONS
The authors proposed a novel immediate CTP assessment to score perfusion mismatch in emergency settings to guide clinicians' decision-making for aggressive treatment and to prevent stroke-related disability.

Identifiants

pubmed: 33646988
doi: 10.1097/NRL.0000000000000315
pii: 00127893-202103000-00004
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

41-46

Informations de copyright

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Déclaration de conflit d'intérêts

The authors declare no conflict of interest.

Références

Global Burden of Disease Stroke Expert Group, Bennett DA. Methodology of the global and regional burden of stroke study. Neuroepidemiology. 2012;38:30–40.
Jauch EC, Saver JL, Adams HP Jr, et al. American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Peripheral Vascular Disease, Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:870–947.
Martins SC, Freitas GR, Pontes-Neto OM, et al. Executive Committee from the Brazilian Stroke Society, the Scientific Department in Cerebrovascular Diseases of the Brazilian Academy of Neurology. Guidelines for acute ischemic stroke treatment: part II: stroke treatment. Arq Neuropsiquiatr. 2012;70:885–893.
Dankbaar JW, Bienfait HP, van den Berg C, et al. on behalf of the DUST Investigators. Wake-up stroke versus stroke with known onset time: clinical and multimodality CT imaging characteristics. Cerebrovasc Dis. 2018;45:236–244.
Powers WJ, Rabinstein AA, Ackerson T, et al. 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. Stroke. 2019;50:e344–e418.
Ma H, Campbell BCV, Parsons MW, et al. Thrombolysis guided by perfusion imaging up to 9 hours after onset of stroke. N Engl J Med. 2019;380:1795–1803.
Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378:11–21.
Caruso P, Naccarato M, Furlanis G, et al. Wake-up stroke and CT perfusion: effectiveness and safety of reperfusion therapy. Neurol Sci. 2018;39:1705–1712.
Furlanis G, Ajčević M, Buoite Stella A, et al. Wake-up stroke: thrombolysis reduces ischemic lesion volume and neurological deficit. J Neurol. 2020;267:666–673.
Campbell BCV, Ma H, Ringleb PA, et al. Extending thrombolysis to 4.5-9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data. Lancet. 2019;394:139–147.
Ajčević M, Furlanis G, Buoite Stella A, et al. A CT perfusion based model predicts outcome in wake-up stroke patients treated with recombinant tissue plasminogen activator. Physiol Meas. 2020;41:075011.
Gonzalez RG. Imaging-guided acute ischemic stroke therapy: from “time is brain” to “physiology is brain”. AJNR Am J Neuroradiol. 2006;27:728–735.
Vilela P, Rowley HA. Brain ischemia: CT and MRI techniques in acute ischemic stroke. Eur J Radiol. 2017;96:162–172.
Parsons MW. Perfusion CT: is it clinically useful? Int J Stroke. 2008;3:41–50.
Ukmar M, Degrassi F, Pozzi Mucelli RA, et al. Perfusion CT in acute stroke: effectiveness of automatically-generated colour maps. Br J Radiol. 2017;90:20150472.
Furlanis G, Ajčević M, Stragapede L, et al. Ischemic volume and neurological deficit: correlation of computed tomography perfusion with the National Institutes of Health Stroke Scale Score in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2018;27:2200–2207.
Barber PA, Demchuk AM, Zhang J, et al. ASPECTS Study Group. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. Lancet. 2000;355:1670–1674.
Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359:1317–1329.
Adams HPJ, Davis PH, Leira EC, et al. Baseline NIH Stroke Scale score strongly predicts outcome after stroke: a report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Neurology. 1999;53:126–131.
Wintermark M, Flanders AE, Velthuis B, et al. Perfusion-CT assessment of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. Stroke. 2006;37:979–985.
Lewandowski CA, Libman R. Acute presentation of stroke. J Stroke Cerebrovasc Dis. 1999;8:117–126.
Michel P, Bogousslavsky J. Penumbra is brain: no excuse not to perfuse. Ann Neurol. 2005;58:661–663.
Stragapede L, Furlanis G, Ajčević M, et al. Brain oscillatory activity and CT perfusion in hyper-acute ischemic stroke. J Clin Neurosci. 2019;69:184–189.
Manganotti P, Furlanis G, Ajčević M, et al. CT perfusion and EEG patterns in patients with acute isolated aphasia in seizure-related stroke mimics. Seizure. 2019;71:110–115.
Granato A, D’Acunto L, Ajčević M, et al. A novel Computed Tomography Perfusion-based quantitative tool for evaluation of perfusional abnormalities in migrainous aura stroke mimic. Neurol Sci. 2020;41:3321–3328.
Caruso P, Furlanis G, Ridolfi M, et al. Safety of early repeated thrombolysis: a case report. Neurologist. 2019;24:143–145.
Albers GW, Lansberg MG, Kemp S, et al. A multicenter randomized controlled trial of endovascular therapy following imaging evaluation for ischemic stroke (DEFUSE 3). Int J Stroke. 2017;12:896–905.
Bivard A, Spratt N, Miteff F, et al. Tissue is more important than time in stroke patients being assessed for thrombolysis. Front Neurol. 2018;9:41.
Eckert B, Kusel T, Leppien A, et al. Clinical outcome and imaging follow-up in acute stroke patients with normal perfusion CT and normal CT angiography. Neuroradiology. 2011;53:79–88.
Iwasawa E, Ichijo M, Ishibashi S, et al. Acute development of collateral circulation and therapeutic prospects in ischemic stroke. Neural Regen Res. 2016;11:368–371.
Thomalla G, Cheng B, Ebinger M, et al. STIR and VISTA Imaging Investigator. DWI-FLAIR mismatch for the identification of patients with acute ischaemic stroke within 4-5 h if symptom onset (PRE-FLAIR): a multicentre observational study. Lancet Neurol. 2011;10:978–986.
Hellier KD, Hampton JL, Guadagno JV, et al. Perfusion CT helps decision making for thrombolysis when there is no clear time of onset. J Neurol Neurosur Ps. 2006;77:417–419.
Bivard A, Levi C, Krishnamurthy V, et al. Perfusion computed tomography to assist decision making for stroke thrombolysis. Brain. 2015;138(pt 7):1919–1931.
Agarwal S, Jones PS, Alawneh JA, et al. Does perfusion computed tomography facilitate clinical decision making for thrombolysis in unselected acute patients with suspected ischaemic stroke? Cerebrovasc Dis. 2011;32:227–233.

Auteurs

Roberta A Pozzi-Mucelli (RA)

Radiology Unit, Department of Medicine, Surgery and Health Sciences.

Giovanni Furlanis (G)

Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy.

Paola Caruso (P)

Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy.

Carlo Lugnan (C)

Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy.

Adrian Zdjelar (A)

Radiology Unit, Department of Medicine, Surgery and Health Sciences.

Ferruccio Degrassi (F)

Radiology Unit, Department of Medicine, Surgery and Health Sciences.

Lorella Bottaro (L)

Radiology Unit, Department of Medicine, Surgery and Health Sciences.

Maja Ukmar (M)

Radiology Unit, Department of Medicine, Surgery and Health Sciences.

Marcello Naccarato (M)

Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy.

Paolo Manganotti (P)

Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy.

Maria A Cova (MA)

Radiology Unit, Department of Medicine, Surgery and Health Sciences.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH