title: CT perfusion-guided versus time-guided mechanical recanalization in acute ischemic stroke patients.
abstract: OBJECTIVE
  Perfusion studies are increasingly used to triage acute stroke patients for endovascular recanalization therapies. We compare the safety and efficacy of CT perfusion (CTP)-guided to time-guided mechanical recanalization in acute ischemic stroke (AIS) patients.
  
  
  METHODS
  A review was conducted on 132 patients, 94 undergoing CTP-guided and 38 undergoing time-guided (maximum 8h from symptom onset) mechanical recanalization at our institution.
  
  
  RESULTS
  The rate of partial-to-complete recanalization did not differ between the CTP and the non-CTP group (78.7% vs. 81.6%, respectively, p=0.71). ICH occurred respectively in 18.1% in the CTP group versus 31.6% in the non-CTP group (p=0.06). The overall in-hospital mortality rate was significantly lower in the CTP group (15.9% vs. 36.8%, p=0.04). In multivariable analysis, CTP-guided patient selection was an independent negative predictor of in-hospital mortality (OR=3.2; p=0.01). CTP-guided patient selection, however, was not a predictor of favorable outcome (Modified Rankin Scale 0-2 or 0-3).
  
  
  CONCLUSIONS
  CTP-based patient selection was associated with lower ICH and mortality rates. Favorable outcomes, however, did not differ between the 2 groups. These results may suggest a possible benefit in terms of in-hospital mortality with CTP-guided triage of AIS patients for endovascular treatment.
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, USA.
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.forename: George
authors.initials: G
authors.lastname: Ghobrial
authors.forename: Stavropoula
authors.initials: S
authors.lastname: Tjoumakaris
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Dumont
authors.forename: L Fernando
authors.initials: LF
authors.lastname: Gonzalez
authors.forename: Samantha
authors.initials: S
authors.lastname: Witte
authors.forename: Justin
authors.initials: J
authors.lastname: Davanzo
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.forename: Ciro
authors.initials: C
authors.lastname: Randazzo
authors.forename: Adam E
authors.initials: AE
authors.lastname: Flanders
authors.forename: David
authors.initials: D
authors.lastname: Hasan
authors.forename: Rohan
authors.initials: R
authors.lastname: Chitale
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenwasser
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000628:therapy*; D016893:Carotid Stenosis / Q000628:therapy; D003627:Data Interpretation, Statistical; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000628:therapy; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010477:Perfusion; D020521:Stroke / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Acute ischemic stroke; Computed tomography perfusion; Penumbra; Selection; Timing