title: Computed tomographic angiography and cerebral blood volume can predict final infarct volume and outcome after recanalization.
abstract: OBJECTIVE
  Recanalization rates are higher in acute anterior stroke treated with stent-retrievers when compared with older techniques. However, some still have sizeable infarcts and poor outcome. This may be related to underestimation of core infarct on nonenhanced computed tomography (NECT). CT angiography (CTA) source images (CTASI) and CT perfusion may be more informative. We hypothesize that core infarct estimation with NECT, CTA, and CT perfusion predicts infarct at 24 hours and outcome after fast recanalization.
  
  
  METHODS
  Consecutive good recanalization patients with proximal anterior circulation stroke were evaluated. We assessed Alberta Stroke Program Early CT Score (ASPECTs) on NECT for subtle early infarct, hypodensity, loss of gray-white (CTASI), and low cerebral blood volume (CBV; CT perfusion). Sensitivity and specificity for predicting infarct by region were calculated.
  
  
  RESULTS
  Of 46 patients, 36 (78%) had successful thrombectomy. Median ASPECTS was 10 for NECT early infarct and frank hypodensity; for CBV, CTASI-ASPECTS was 8. CTASI had the highest sensitivity of 71% and specificity of 82% for 24 hours NECT infarct. There was moderate correlation and concordance between CBV/24-hour NECT (Rp=0.51; Rc=0.50) and CTASI/24-hour NECT (Rp=0.54 and Rc=0.53). Thirty-four patients (74%) had good outcomes. Median ASPECTS was higher on CTASI (8 versus 5; P=0.04) and CBV (9 versus 5; P=0.03) for patients with good versus bad outcome. There were better outcomes with increasing CTASI-ASPECTS (P=0.004) and CBV-ASPECTS (P=0.02).
  
  
  CONCLUSIONS
  CTASI and CBV were better at predicting 24-hour infarct and outcome than NECT. Appropriate advanced imaged guided selection may improve outcomes in large-vessel stroke treated with the newest techniques.
authors.affiliation: From the Interventional Neuroradiology Section, Department of Medical Imaging-Diagnostic (C.L., M.E.A., S.P., R.T., D.I., H.L., M.d.S.) and Division of Neurology, Department of Medicine (M.H., D.D.), The Ottawa Hospital, Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, Ontario, Canada. chlum@ottawahospital.on.ca.
authors.forename: Cheemun
authors.initials: C
authors.lastname: Lum
authors.affiliation: From the Interventional Neuroradiology Section, Department of Medical Imaging-Diagnostic (C.L., M.E.A., S.P., R.T., D.I., H.L., M.d.S.) and Division of Neurology, Department of Medicine (M.H., D.D.), The Ottawa Hospital, Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Muhammad Ejaz
authors.initials: ME
authors.lastname: Ahmed
authors.affiliation: From the Interventional Neuroradiology Section, Department of Medical Imaging-Diagnostic (C.L., M.E.A., S.P., R.T., D.I., H.L., M.d.S.) and Division of Neurology, Department of Medicine (M.H., D.D.), The Ottawa Hospital, Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Satya
authors.initials: S
authors.lastname: Patro
authors.affiliation: From the Interventional Neuroradiology Section, Department of Medical Imaging-Diagnostic (C.L., M.E.A., S.P., R.T., D.I., H.L., M.d.S.) and Division of Neurology, Department of Medicine (M.H., D.D.), The Ottawa Hospital, Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Thornhill
authors.affiliation: From the Interventional Neuroradiology Section, Department of Medical Imaging-Diagnostic (C.L., M.E.A., S.P., R.T., D.I., H.L., M.d.S.) and Division of Neurology, Department of Medicine (M.H., D.D.), The Ottawa Hospital, Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hogan
authors.affiliation: From the Interventional Neuroradiology Section, Department of Medical Imaging-Diagnostic (C.L., M.E.A., S.P., R.T., D.I., H.L., M.d.S.) and Division of Neurology, Department of Medicine (M.H., D.D.), The Ottawa Hospital, Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Daniela
authors.initials: D
authors.lastname: Iancu
authors.affiliation: From the Interventional Neuroradiology Section, Department of Medical Imaging-Diagnostic (C.L., M.E.A., S.P., R.T., D.I., H.L., M.d.S.) and Division of Neurology, Department of Medicine (M.H., D.D.), The Ottawa Hospital, Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Howard
authors.initials: H
authors.lastname: Lesiuk
authors.affiliation: From the Interventional Neuroradiology Section, Department of Medical Imaging-Diagnostic (C.L., M.E.A., S.P., R.T., D.I., H.L., M.d.S.) and Division of Neurology, Department of Medicine (M.H., D.D.), The Ottawa Hospital, Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Marlise
authors.initials: M
authors.lastname: Dos Santos
authors.affiliation: From the Interventional Neuroradiology Section, Department of Medical Imaging-Diagnostic (C.L., M.E.A., S.P., R.T., D.I., H.L., M.d.S.) and Division of Neurology, Department of Medicine (M.H., D.D.), The Ottawa Hospital, Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Dar
authors.initials: D
authors.lastname: Dowlatshahi
mesh_terms: D015415:Biomarkers; D001810:Blood Volume; D020520:Brain Infarction / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation; D006801:Humans; D008279:Magnetic Resonance Imaging; D010477:Perfusion; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D000071939:Stroke Rehabilitation; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers
keywords: biomarkers; neuroimaging; stroke