Value of Computed Tomographic Perfusion-Based Patient Selection for Intra-Arterial Acute Ischemic Stroke Treatment

Jordi Borst*, Olvert A. Berkhemer, Yvo B. W. E. M. Roos, Ed van Bavel, Wim H. van Zwam, Robert J. van Oostenbrugge, Marianne A. A. van Walderveen, Hester F. Lingsma, Aad van der Lugt, Diederik W. J. Dippel, Albert J. Yoo, Henk A. Marquering, Charles B. L. M. Majoie

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

72 Citations (Web of Science)

Abstract

Background and Purpose-The utility of computed tomographic perfusion (CTP)-based patient selection for intra-arterial treatment of acute ischemic stroke has not been proven in randomized trials and requires further study in a cohort that was not selected based on CTP. Our objective was to study the relationship between CTP-derived parameters and outcome and treatment effect in patients with acute ischemic stroke because of a proximal intracranial arterial occlusion. Methods-We included 175 patients who underwent CTP in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands (MR CLEAN). Association of CTP-derived parameters (ischemic-core volume, penumbra volume, and percentage ischemic core) with outcome was estimated with multivariable ordinal logistic regression as an adjusted odds ratio for a shift in the direction of a better outcome on the modified Rankin Scale. Interaction between CTP-derived parameters and treatment effect was determined using multivariable ordinal logistic regression. Interaction with treatment effect was also tested for mismatch (core 1.2; penumbra core >10 mL). Results-The adjusted odds ratio for improved functional outcome for ischemic core, percentage ischemic core, and penumbra were 0.79 per 10 mL (95% confidence interval: 0.71-0.89; P
Original languageEnglish
Pages (from-to)3375-3382
JournalStroke
Volume46
Issue number12
DOIs
Publication statusPublished - Dec 2015

Keywords

  • computed tomography
  • interventional neuroradiology
  • ischemic stroke
  • perfusion imaging
  • stroke

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