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(Stroke. 2004;35:357.)
© 2004 American Heart Association, Inc.

Advances in Stroke 2003

Reborn Workhorse, CT, Pulls the Wagon Toward Thrombolysis Beyond 3 Hours

Markku Kaste, MD, PhD

From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.

Correspondence to Dr Markku Kaste, Dept of Neurology, Helsinki University Central Hospital, FIN-00029, HUS Helsinki, Finland. E-mail markku.kaste@hus.fi

Key Words: Advances in Stroke • computed tomography • thrombolysis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Computed tomography (CT) is the time-honored workhorse of every emergency room and has revolutionized the speed and accuracy of the diagnosis of stroke. It is used to select patients for thrombolysis, the only approved drug treatment for ischemic brain infarction. However, the criteria for eligibility are very restrictive, notably with respect to the accepted 3-hour window. Only in a few centers >10% of ischemic stroke patients will receive thrombolysis, although it has been estimated that if all patients arrived within 3 hours from the onset of symptoms, 45% could be eligible for thrombolysis.¹ However, there probably is no absolute time window of tissue viability. More likely, brain tissue viability includes 4 factors: a time factor, a hemodynamic factor, a tissue factor, and an intervention factor.² How to know when to provide thrombolysis after the 3-hour window is an enigma. Dynamic perfusion CT may be an answer³ because it wins on accessibility, speed, and low cost. Other imaging methods such as positron-emission tomography, functional MRI, and single-photon emission computed tomography are not available in busy emergency rooms, but every stroke center has the needed hardware, CT. Only new software is needed to be able to perform perfusion CT.

Dynamic Perfusion Computed Tomography Technology

Dynamic perfusion CT is a functional CT that allows accurate quantitative assessment of regional blood flow (rCBF) and regional blood volume (rCBV) in a single slice of brain, but with multislice technology it is possible to cover a wider part brain.³ Perfusion CT can be completed within minutes and involves the sequential acquisition . . . [Full Text of this Article]

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