title: CT perfusion-guided patient selection for endovascular recanalization in acute ischemic stroke: a multicenter study.
abstract: BACKGROUND
  The treatment of acute ischemic stroke is traditionally centered on time criteria, although recent evidence suggests that physiologic neuroimaging may be useful. In a multicenter study we evaluated the use of CT perfusion, regardless of time from symptom onset, in patients selected for intra-arterial treatment of ischemic stroke.
  
  
  METHODS
  Three medical centers retrospectively assessed stroke patients with a National Institute of Health Stroke Scale of ≥ 8, regardless of time from symptom onset. CT perfusion maps were qualitatively assessed. Patients with defined salvageable penumbra underwent intra-arterial revascularization of their occlusion. Functional outcome using the modified Rankin Score (mRS) was recorded.
  
  
  RESULTS
  Two hundred and forty-seven patients were selected to undergo intra-arterial treatment based on CT perfusion imaging. The median time from symptom onset to procedure was 6 h. Patients were divided into two groups for analysis: ≤ 8 h and >8 h from symptom onset to endovascular procedure. We found no difference in functional outcome between the two groups (42.8% and 41.9% achieved 90-day mRS ≤ 2, respectively (p=1.0), and 54.9% vs 55.4% (p=1.0) achieved 90-day mRS ≤ 3, respectively). Overall, 48 patients (19.4%) had hemorrhages, of which 20 (8.0%) were symptomatic, with no difference between the groups (p=1.0).
  
  
  CONCLUSIONS
  In a multicenter study, we demonstrated similar rates of good functional outcome and intracranial hemorrhage in patients with ischemic stroke when endovascular treatment was performed based on CT perfusion selection rather than time-guided selection. Our findings suggest that physiologic imaging-guided patient selection rather than time for endovascular reperfusion in ischemic stroke may be effective and safe.
authors.affiliation: Department of Radiology, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Aquilla S
authors.initials: AS
authors.lastname: Turk
authors.forename: Jordan Asher
authors.initials: JA
authors.lastname: Magarick
authors.forename: Don
authors.initials: D
authors.lastname: Frei
authors.forename: Kyle Michael
authors.initials: KM
authors.lastname: Fargen
authors.forename: Imran
authors.initials: I
authors.lastname: Chaudry
authors.forename: Christine A
authors.initials: CA
authors.lastname: Holmstedt
authors.forename: Joyce
authors.initials: J
authors.lastname: Nicholas
authors.forename: J
authors.initials: J
authors.lastname: Mocco
authors.forename: Raymond D
authors.initials: RD
authors.lastname: Turner
authors.forename: Daniel
authors.initials: D
authors.lastname: Huddle
authors.forename: David
authors.initials: D
authors.lastname: Loy
authors.forename: Richard
authors.initials: R
authors.lastname: Bellon
authors.forename: Gwendolyn
authors.initials: G
authors.lastname: Dooley
authors.forename: Robert
authors.initials: R
authors.lastname: Adams
authors.forename: Michelle
authors.initials: M
authors.lastname: Whaley
authors.forename: Chris
authors.initials: C
authors.lastname: Fanale
authors.forename: Edward
authors.initials: E
authors.lastname: Jauch
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000601:surgery*; D002548:Cerebral Revascularization / Q000009:adverse effects / Q000379:methods*; D003627:Data Interpretation, Statistical; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010477:Perfusion; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator