Automated CT Perfusion for Ischemic Core Volume Prediction in Tandem Anterior Circulation Occlusions.
OBJECTIVE
CT perfusion (CTP) predicts ischemic core volumes in acute ischemic stroke (AIS); however, assumptions made within the pharmacokinetic model may engender errors by the presence of tracer delay or dispersion. We aimed to evaluate the impact of hemodynamic disturbance due to extracranial anterior circulation occlusions upon the accuracy of ischemic core volume estimation with an automated perfusion analysis tool (RAPID) among AIS patients with large-vessel occlusions.


METHODS
A prospectively collected, interventional database was retrospectively reviewed for all cases of endovascular treatment of AIS between September 2010 and March 2015 for patients with anterior circulation occlusions with baseline CTP and full reperfusion (mTICI3).


RESULTS
Out of 685 treated patients, 114 fit the inclusion criteria. Comparison between tandem (n = 21) and nontandem groups (n = 93) revealed similar baseline ischemic core (20 ± 19 vs. 19 ± 25 cm(3); p = 0.8), Tmax >6 s (175 ± 109 vs. 162 ± 118 cm(3); p = 0.6), Tmax >10 s (90 ± 84 vs. 90 ± 91 cm(3); p = 0.9), and final infarct volumes (45 ± 47 vs. 37 ± 45 cm(3); p = 0.5). Baseline core volumes were found to correlate with final infarct volumes for the tandem (r = 0.49; p = 0.02) and nontandem (r = 0.44; p < 0.01) groups. The mean absolute difference between estimated core and final infarct volume was similar between patients with and those without (24 ± 41 vs. 17 ± 41 cm(3); p = 0.5) tandem lesions.


CONCLUSIONS
The prediction of baseline ischemic core volumes through an optimized CTP analysis employing rigorous normalization, thresholding, and voxel-wise analysis is not significantly influenced by the presence of underlying extracranial carotid steno-occlusive disease in large-vessel AIS.
Emory University and Grady Memorial Hospital, Atlanta, Ga., USA.
Diogo C
DC
Haussen
Emory University and Grady Memorial Hospital, Atlanta, Ga., USA.
Seena
S
Dehkharghani
Emory University and Grady Memorial Hospital, Atlanta, Ga., USA.
Mikayel
M
Grigoryan
Emory University and Grady Memorial Hospital, Atlanta, Ga., USA.
Meredith
M
Bowen
Emory University and Grady Memorial Hospital, Atlanta, Ga., USA.
Leticia C
LC
Rebello
Emory University and Grady Memorial Hospital, Atlanta, Ga., USA.
Raul G
RG
Nogueira
Computed tomography; Endovascular treatment; Ischemic stroke; Perfusion imaging