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Defining CT Perfusion Thresholds for Infarction in the Golden Hour and With Ultra-Early Reperfusion

  • Mohamed Najm (a1) (a2), Fahad S. Al-Ajlan (a1) (a3) (a4), Mari E. Boesen (a2), Lisa Hur (a1), Chi Kyung Kim (a1) (a5), Enrico Fainardi (a6), Michael D. Hill (a1) (a3) (a7) (a8) (a2), Andrew M. Demchuk (a1) (a3) (a8) (a2), Mayank Goyal (a1) (a3) (a8) (a2), Ting Y. Lee (a3) (a9) and Bijoy K. Menon (a1) (a3) (a7) (a8) (a2)...

Abstract

In this brief report, computed tomography perfusion (CTP) thresholds predicting follow-up infarction in patients presenting <3 hours from stroke onset and achieving ultra-early reperfusion (<45 minutes from CTP) are reported. CTP thresholds that predict follow-up infarction vary based on time to reperfusion: Tmax >20 to 23 seconds and cerebral blood flow <5 to 7 ml/min−1/(100 g)−1 or relative cerebral blood flow <0.14 to 0.20 optimally predicted the final infarct. These thresholds are stricter than published thresholds.

Seuils limites d’un examen de tomodensitométrie couplé à une perfusion administré à des patients victimes d’un accident ischémique et aux prises avec un processus de reperfusion très précoce se présentant en temps opportun. Dans ce bref compte-rendu, il est question des seuils limites obtenus à la suite d’un examen de tomodensitométrie couplé à une perfusion. Ces seuils limites peuvent prédire le suivi de patients ayant subi un accident ischémique. Les patients à l’étude devaient s’être présentés moins de 3 heures après l’apparition de l’accident ischémique et avoir montré très tôt des signes de reperfusion (moins de 45 minutes à la suite d’un examen de tomodensitométrie). Les seuils limites pouvant prédire l’évolution de patients à la suite d’un accident ischémique vont varier selon le temps de reperfusion. Cela dit, une durée dépassant les 20 à 23 secondes et un débit sanguin cérébral inférieur à 5-7 ml/min−1/(100 g)−1 ou bien un débit sanguin cérébral relatif inférieur à 0,14-0,20 ont permis de prédire de façon optimale un AVC. Précisons que ces seuils limites sont plus sévères que ceux ayant été publiés antérieurement.

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Copyright

Corresponding author

Correspondence to: Bijoy K. Menon, Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, 1079 A, 29th Street NW, Calgary, AB, Canada T2N2T9. Email: docbijoymenon@gmail.com

Footnotes

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Part of these results was presented the 68th AAN Annual Meeting, April 15-21, 2016, Vancouver, BC, Canada.

Footnotes

References

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1. Goyal, M, Demchuk, AM, Menon, BK, et al. ESCAPE Trial Investigators. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372:1019-1030.
2. d’Esterre, CD, Boesen, ME, Ahn, SH, et al. Time-dependent computed tomographic perfusion thresholds for patients with acute ischemic stroke. Stroke. 2015;46:3390-3397.
3. Menon, BK, d’Esterre, CD, Qazi, EM, et al. Multiphase CT angiography: a new tool for the imaging triage of patients with acute ischemic stroke. Radiology. 2015:142256.
4. Bivard, A, Levi, C, Krishnamurthy, V, et al. Defining acute ischemic stroke tissue pathophysiology with whole brain ct perfusion. J Neuroradiol. 2014;41:307-315.
5. Bivard, A, Levi, C, Spratt, N, Parsons, M. Perfusion ct in acute stroke: a comprehensive analysis of infarct and penumbra. Radiology. 2013;267:543-550.
6. Campbell, BC, Christensen, S, Levi, CR, et al. Cerebral blood flow is the optimal ct perfusion parameter for assessing infarct core. Stroke. 2011;42:3435-3440.
7. Qiao, Y, Zhu, G, Patrie, J, et al. Optimal perfusion computed tomographic thresholds for ischemic core and penumbra are not time dependent in the clinically relevant time window. Stroke. 2014;45:1355-1362.

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