Abstract T P33: Separating Acute Infarct Core From Penumbra Using Optimized Imaging And Standardized Post-processing In The Setting Of Ischemic Stroke: A CT Perfusion Study
Background: In the setting of acute ischemic stroke, CT Perfusion (CTP) may change thrombolytic/endovascular treatment decisions when compared to NCCT/CTA alone. Two distinct thresholds may be useful in this regard: separation of 1) non-salvageable tissue (infarct core) from salvageable electrically silent tissue (penumbra), and 2) penumbra from benign oligemia (hypoperfused, but will survive if clot persists).
Methods: CTP (120s,8cm) was performed on 180 patients within 12hrs of ischemic stroke. Two patient cohorts were analyzed: (1) recanalization (TICI 2b,3) 6s. For group (2) CBF, CBV, and Tmax values were obtained from within the final infarct region, and total ipsilateral hemisphere, excluding infarction. CBF, CBV and Tmax were used in univariate regression models.
Results: For group (1)[n=11], mean time from CTP to recanalization was 60±19min. CBF parameter (thresholds for gray and white matter 7.2 and 5.2 ml•min-1•(100g)-1) had the highest sensitivity (90.9%) and specificity (81.8%) for infarction. For group (2)[n=15], the Tmax parameter (thresholds for gray and white matter 11.3s and 11.8s) had the highest sensitivity (86.6%) and specificity (80.0%) for penumbra.
Conclusion: CTP thresholds derived from ultra-early reperfusers could potentially best define what is clinically dead in patients with acute ischemic stroke
Author Disclosures: C. d'Esterre: None. E. Qazi: None. S. Patil: None. E. Fainardi: None. M. Rubiera: None. A. Khaw: None. T. Lee: None. M. Almekhlafi: None. R. Frayne: None. A.M. Demchuk: Honoraria; Modest; Covidien honoraria for CME. Research Grant; Significant; Unrestricted grant for ESCAPE trial: Covidien. M. Goyal: None. B. Menon: None.
- © 2015 by American Heart Association, Inc.