Semiquantitative dynamic computed tomography to predict response to anti-platelet therapy in acute cerebral infarction.
We investigated whether dynamic computed tomography (CT) in patients with acute cerebral infarction could identify patients likely to respond to anti-platelet therapy. Seventy patients underwent semiquantitative dynamic CT within 6 h as well as cerebral angiography. All then received anti-platelet therapy with a thromboxane A2 synthetase inhibitor. Peak value (pv) and time-to-peak (tp) (time-density curves) for the Sylvian fissure were extracted from dynamic CT data and standardizing interpatient data, two indices, PV/TP index and TP index, were prepared following a standard semiquantitative manner. Both PV/TP index and TP index were effective in discriminating between 48 responders (modified Rankin scale (mRS): 0 to 2) and 22 non-responders (mRS: 3 to 5, or death: 6; both P<0.0001). High PV/TP index (>or=0.8) was a strong indicator of favorable response. Most of these patients maintained regional cerebral blood flow (rCBF) via anterograde flow or collaterals, with a TP index <or=1.1. Low PV/TP index (<or=0.4) predicted non-response associated with increased TP index (>1.1) and non-compensated rCBF. Intermediate PV/TP values could not predict outcome. Dynamic CT prior to therapy can identify patients with acute cerebral infarction who are treatable with anti-platelet therapy alone.
Chokyu
K
K
Department of Neurosurgery, Kochi Medical School, Kohasu, Okou, Nankoku, Kochi 783-8505, Japan. choukyuu-nsu@umin.ac.jp
Fukumoto
M
M
Mori
T
T
Mokudai
T
T
Mori
K
K
Shimizu
K
K
D000208:Acute Disease; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000188:drug therapy; D008297:Male; D008689:Methacrylates / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D011379:Prognosis; D013930:Thromboxane-A Synthase / Q000037:antagonists & inhibitors*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D004791:Enzyme Inhibitors; D008689:Methacrylates; D010975:Platelet Aggregation Inhibitors; D013930:Thromboxane-A Synthase; C034364:ozagrel