CT Perfusion to Predict Response to Recanalization in Ischemic Stroke

Abstract

Objective: To assess the utility of CT perfusion for selection of patients for endovascular therapy up to 18 hours after symptom onset.

Methods: We conducted a multicenter cohort study of consecutive acute stroke patients scheduled to undergo endovascular therapy within 90 min after a baseline CTP. Patients were classified as 'target mismatch' if they had a small ischemic core and a large penumbra on their baseline CT perfusion. Reperfusion was defined as >50% reduction in critical hypoperfusion between the baseline CT perfusion and the 36-hour follow-up MRI.

Results: Of the 201 patients enrolled, 190 patients with an adequate baseline CT perfusion study who underwent angiography were included; mean age 66 years, median NIHSS 16, median time from symptom onset to endovascular therapy 5.2 hours. Rate of reperfusion was 89%. In patients with target mismatch (n=131), reperfusion was associated with higher odds of favorable clinical response, defined as an improvement of ≥8 points on the NIH Stroke Scale (83% vs 44%, p=0.002; adjusted OR=6.6; 95% CI 2.1-20.9). This association did not differ between patients treated within 6 hrs (OR = 6.4; 95% CI 1.5-27.8) and those treated beyond 6 hrs after symptom onset (OR = 13.7; 95% CI 1.4-140).

Interpretation: The robust association between endovascular reperfusion and good outcome among patients with the CT perfusion target mismatch profile treated up to 18 hours after symptom onset supports a randomized trial of endovascular therapy in this patient population. This article is protected by copyright. All rights reserved.

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