Kirsteen Rennie Burton MD, MBA, Presenter: Nothing to Disclose

Del Dhanoa MD, Abstract Co-Author: Nothing to Disclose

Richard Aviv MBBCh, FRCR, Abstract Co-Author: Nothing to Disclose

Alan Rowland Moody MD, Abstract Co-Author: Nothing to Disclose

Moira Kapral, Abstract Co-Author: Nothing to Disclose

Andreas Laupacis, Abstract Co-Author: Nothing to Disclose

A systematic review of outcomes of patients with suspected acute ischemic stroke (AIS) selected for thrombolytic therapy within three hours and beyond using perfusion computed tomography (CTP) imaging, has not been published. We sought to determine rates of death, disability and symptomatic intracranial hemorrhage (SICH) among patients with AIS selected for thrombolytic therapy using CTP imaging.

We performed a literature search using MEDLINE, EMBASE, the Cochrane Library, PubMed, and Google Scholar up to August 2012, using terms including “brain ischemia” and “perfusion imaging”, and unrestricted by language of publication. Experimental and observational studies were included. Two reviewers extracted study data and independently assessed risk of bias for each selected study. CTP-selected patient outcomes were estimated including case-fatality rate, favourable outcome (modified Rankin Scale score <=2) and rates of SICH.

We identified 14 studies that included a total of 600 patients who received intravenous thrombolysis following CTP imaging. The methodological quality of the small studies was generally good. Overall, 90-day mortality was 12.1% (95% CI, 8.4-16.4%). Among those treated within 3 hours of symptom onset, mortality was 14.4% (95% CI, 8.2-22.1%), a favourable outcome (modified Rankin Scale score <=2) was seen in 44.9% (95% CI, 29.2-61.3%) and the symptomatic intracranial hemorrhage rate was 5.1% (95% CI, 3.0-7.8%). Among those treated after 3 hours of symptom onset, mortality was 8.5% (95% CI, 2.4-18.0%), 61.5% (95% CI, 51.3-71.1%) had a favourable outcome, and 4.1% (95% CI, 0.9-9.3%) had a SICH.

The outcomes of patients selected for thrombolysis using CTP imaging appear to be similar to those of patients selected using other imaging modalities except for SICH, wherein MRI selection within 3 hours was safer than CTP and NCCT was less so. Some patients can be safely treated up to 9 hours after stroke onset. Direct comparisons between CTP and other imaging modalities are needed.

Outcomes for acute ischemic stroke patients selected for thrombolysis by CTP are comparable to other imaging modalities, except for SICH rates, which differ in NCCT, CTP and MRI-selected patients.

Burton, K, Dhanoa, D, Aviv, R, Moody, A, Kapral, M, Laupacis, A, Perfusion Computed Tomography for Selection of Adult Patients with Acute Ischemic Stroke for Intravenous Thrombolytic Therapy—A Systematic Review and Meta-analysis.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14003659.html