title: Influence of Recanalization and Time of Cerebral Ischemia on Tissue Outcome after Endovascular Stroke Treatment on Computed Tomography Perfusion.
abstract: BACKGROUND
  The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) has been proposed as a straightforward alternative to the less reliable visual estimation of tissue at risk. We evaluated the association between admission ASPECTS on computed tomography perfusion (CTP) parameter maps and final infarct ASPECTS in patients with acute ischemic stroke who were treated by endovascular therapy (eT) and compared the results with thrombolysis candidates treated conservatively.
  
  
  METHODS
  eT was performed in 26 consecutive ischemic stroke patients within 6 hours of symptom onset. The control group was matched for age and admission National Institutes of Health Stroke Scale having the same admission imaging protocol and a transcranial Doppler sonography within 24 hours. ASPECTS determined from CTP maps of cerebral blood flow (CBF), cerebral blood volume (CBV), and time to peak (TTP) were compared with final infarct ASPECTS on day 5 noncontrast CT.
  
  
  RESULTS
  Recanalization rate was 73% in treatment and 50% in control group. ASPECTS for all CTP parameters were significantly lower than ASPECTS-CT in both groups (P < .005). In the treatment group, this applied to patients with successful recanalization. Only controls without recanalization showed a strong correlation between ASPECTS-CTP parameters and ASPECTS-CT (CBV: P = .005; CBF and TTP: P = .028). Patients with early recanalization (≤4 hours) had greater differences between ASPECTS-CTP and ASPECTS-CT than patients with late recanalization (>4 hours; CBF: P = .056; CBV: P = .095; TTP: P = .048).
  
  
  CONCLUSIONS
  The initial ASPECTS-CTP lesion was significantly larger than the final infarct determined by ASPECTS in case of recanalization. Initial perfusion lesion, including CBV, is reversible in case of reperfusion, especially in early reperfusion.
authors.affiliation: Department of Neurology, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Anselm
authors.initials: A
authors.lastname: Angermaier
authors.affiliation: Department of Clinical Neurosciences, University of Western Ontario, London Health Sciences Centre, London, Ontario, Canada; Department of Neurology, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Alexander V
authors.initials: AV
authors.lastname: Khaw
authors.affiliation: Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Kirsch
authors.affiliation: Department of Neurology, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Kessler
authors.affiliation: Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany. Electronic address: soenke.langner@uni-greifswald.de.
authors.forename: Soenke
authors.initials: S
authors.lastname: Langner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation / Q000502:physiology*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015424:Reperfusion; D020521:Stroke / Q000628:therapy*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: ASPECTS; Ischemic stroke; endovascular intervention; intra-arterial thrombolysis; perfusion CT