Noncontrast CT versus Perfusion-Based Core Estimation in Large Vessel Occlusion: The Blood Pressure after Endovascular Stroke Therapy Study

Research output: Contribution to journalArticle

Authors

  • James E. Siegler
  • Heidi Sucharew
  • Scott E. Kasner
  • Tapan Mehta
  • Niraj Arora
  • Amy K. Starosciak
  • Felipe De Los Rios La Rosa
  • Natasha R. Barnhill
  • Akshitkumar M. Mistry
  • Kishan Patel
  • Salman Assad
  • Amjad Tarboosh
  • Katarina Dakay
  • Jeff Wagner
  • Alicia Bennett
  • Bharathi Jagadeesan
  • Christopher Streib
  • Stewart A. Weber
  • Rohan Chitale
  • John J. Volpi
  • Stephan A. Mayer
  • Mahesh V. Jayaraman
  • Pooja Khatri
  • Eva A. Mistry

External Institution(s)

  • Hospital of University of Pennsylvania
  • University of Cincinnati
  • University of Minnesota Twin Cities
  • Fairview Health Service
  • Hennepin County Medical Center
  • University of Miami
  • Baptist Health Neuroscience Center
  • Oregon Health and Science University
  • Vanderbilt University
  • Houston Methodist
  • Henry Ford Health System
  • Brown University
  • Blue Sky Neurology

Details

Original languageEnglish (US)
Pages (from-to)219-226
Number of pages8
JournalJournal of Neuroimaging
Volume30
Issue number2
StatusPublished - Mar 1 2020
Peer-reviewedYes

Abstract

BACKGROUND AND PURPOSE: The 2018 AHA guidelines recommend perfusion imaging to select patients with acute large vessel occlusion (LVO) for thrombectomy in the extended window. However, the relationship between noncontrast CT and CT perfusion imaging has not been sufficiently characterized >6 hours after last known normal (LKN). METHODS: From a multicenter prospective cohort of consecutive adults who underwent thrombectomy for anterior LVO 0–24 hours after LKN, we correlated baseline core volume (rCBF < 30%) and the Alberta Stroke Program Early CT Scale (ASPECTS) score. We compared perfusion findings between patients with an unfavorable ASPECTS (<6) against those with a favorable ASPECTS (≥6), and assessed findings over time. RESULTS: Of 485 enrolled patients, 177 met inclusion criteria (median age: 69 years, interquartile range [IQR: 57-81], 49% female, median ASPECTS 8 [IQR: 6-9], median core 10 cc [IQR: 0-30]). ASPECTS and core volume moderately correlated (r = −.37). A 0 cc core was observed in 54 (31%) patients, 70% of whom had ASPECTS <10. Of the 28 patients with ASPECTS <6, 3 (11%) had a 0 cc core. After adjustment for age and stroke severity, there was a lower ASPECTS for every 1 hour delay from LKN (cOR: 0.95, 95% confidence of interval [CI]: 0.91-1.00, P =.04). There was no difference in core (P =.51) or penumbra volumes (P =.87) across patients over time. CONCLUSIONS: In this multicenter prospective cohort of patients who underwent thrombectomy, one-third of patients had normal CTP core volumes despite nearly three quarters of patients showing ischemic changes on CT. This finding emphasizes the need to carefully assess both noncontrast and perfusion imaging when considering thrombectomy eligibility.

    Research areas

  • CT, CT Perfusion, Stroke

Citation formats

APA

Siegler, J. E., Messé, S. R., Sucharew, H., Kasner, S. E., Mehta, T., Arora, N., ... Mistry, E. A. (2020). Noncontrast CT versus Perfusion-Based Core Estimation in Large Vessel Occlusion: The Blood Pressure after Endovascular Stroke Therapy Study. Journal of Neuroimaging, 30(2), 219-226. https://doi.org/10.1111/jon.12682

Harvard

Siegler, JE, Messé, SR, Sucharew, H, Kasner, SE, Mehta, T, Arora, N, Starosciak, AK, De Los Rios La Rosa, F, Barnhill, NR, Mistry, AM, Patel, K, Assad, S, Tarboosh, A, Dakay, K, Wagner, J, Bennett, A, Jagadeesan, B, Streib, C, Weber, SA, Chitale, R, Volpi, JJ, Mayer, SA, Yaghi, S, Jayaraman, MV, Khatri, P & Mistry, EA 2020, 'Noncontrast CT versus Perfusion-Based Core Estimation in Large Vessel Occlusion: The Blood Pressure after Endovascular Stroke Therapy Study', Journal of Neuroimaging, vol. 30, no. 2, pp. 219-226. https://doi.org/10.1111/jon.12682