title: Correlation between cerebral blood volume values and outcomes in endovascular therapy for acute ischemic stroke.
abstract: BACKGROUND
  Neurointerventionalists do not agree about the optimal imaging protocol when evaluating patients with acute stroke for potential endovascular revascularization. Preintervention cerebrovascular blood volume (CBV) has been shown to predict outcomes in patients undergoing intra-arterial stroke therapies.
  
  
  OBJECTIVE
  To determine whether CBV can predict hemorrhagic transformation and clinical outcomes in patients selected for endovascular therapy for acute ischemic middle cerebral artery (MCA) stroke using a CT perfusion (CTP)-based imaging protocol.
  
  
  METHODS
  We retrospectively reviewed cases of acute ischemic stroke due to MCA M1 segment occlusion and correlated favorable clinical outcomes (modified Rankin scale (mRS) ≤2) and radiographic outcomes with preintervention CBV values. All patients underwent whole-brain (320-detector-row) CTP imaging, and absolute CBV values of the affected and contralateral MCA territories were obtained separately for the cortical and basal ganglia regions.
  
  
  RESULTS
  Relative CBV (rCBV) of the MCA cortical regions was significantly lower in patients with poor clinical outcomes than in those with favorable clinical outcomes (0.87±0.21 vs 1.02±0.09, p=0.0003), and a negative correlation was found between rCBV values and mRS score severity. rCBV of the basal ganglia region was significantly lower in patients with hemorrhagic infarction (p=0.004) and parenchymal hematoma (p=0.04) than in those without hemorrhagic transformation.
  
  
  CONCLUSIONS
  We found that cortical CBV loss is predictive of poor clinical outcomes, whereas basal ganglia CBV loss is predictive of hemorrhagic transformation but without translation into poor clinical outcomes. Our study findings support published results of baseline preintervention CBV as a predictor of outcomes in patients undergoing intra-arterial stroke therapies.
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
authors.forename: Maxim
authors.initials: M
authors.lastname: Mokin
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
authors.forename: Simon
authors.initials: S
authors.lastname: Morr
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Fanous
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
authors.forename: Hussain
authors.initials: H
authors.lastname: Shallwani
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
authors.forename: Sabareesh K
authors.initials: SK
authors.lastname: Natarajan
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA.
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.
authors.forename: Kenneth V
authors.initials: KV
authors.lastname: Snyder
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA Jacobs Institute, Buffalo, New York, USA.
authors.forename: Adnan H
authors.initials: AH
authors.lastname: Siddiqui
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001479:Basal Ganglia / Q000098:blood supply*; D001810:Blood Volume / Q000187:drug effects / Q000502:physiology*; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000188:drug therapy; D002540:Cerebral Cortex / Q000098:blood supply*; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000188:drug therapy; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015912:Thrombolytic Therapy / Q000379:methods*
keywords: CT perfusion; Stroke; Technique; Technology