Agustina Vicente Bartulos MD, Presenter: Nothing to Disclose

Michal Kawiorski ?, Abstract Co-Author: Nothing to Disclose

Daniel Lourido Garcia, Abstract Co-Author: Nothing to Disclose

Luis Gorospe Sarasua, Abstract Co-Author: Nothing to Disclose

Alfonso Muriel Garcia, Abstract Co-Author: Nothing to Disclose

Maria Alonso de Lecinana Cases, Abstract Co-Author: Nothing to Disclose

The mismatch hypothesis has been used to identify recoverable tissue in acute stroke. However, its utility has been questioned. We performed a study to determine whether CT perfusion (CTP) accurately identify salvable tissue and if the findings have a translation into clinic.    

Prospective registry of patients with severe anterior circulation stroke subjected to reperfusion therapies. We recorded clinical characteristics, urgent neuroimaging data (baseline multimodal CT, non-contrast CT at 24 hours), occurrence of recanalization and outcomes at three months(NIHSS and mRS). Volumetric measurement of infarct core (reduced blood volume) and at risk tissue (reduced blood flow with normal volume) in CTP were performed. In 24-h-CT total volume of lesion (TVL) and partial volume (PVL) of lesion in the slices corresponding to the perfusion acquisition cage, were measured. Percentage of at risk tissue not incorporated to the final lesion was estimated and correlated with outcomes  

34 patients were included, median age 66.5 years (P25; P75: 60; 75). Baseline NIHSS 17 (14; 22). Location of the thrombus was: 21% Intracranial ICA, 62% M1 and 17% M2 segment of the MCA. Lesion volumes were: Core: 10,6 mL (4;18); at risk tissue: 74.3 mL (56; 91); mismatch 89% (79; 95), TVL: 12.4 mL (8;54); PVL: 10.7 mL (5; 33). Percentage of at risk tissue that did not incorporate into the final lesion was reduced when recanalization occurred: 89 % (76; 94) vs 46 % (23; 86), p =0.0044). For every 10 % of preserved tissue, NIHSS score improved by 3 points (95% CI: -4.9 - -0.8, p=0.007). Higher percentage of preserved tissue increased probability of independency (mRS 0-2) OR 1.15 (95% CI 1.04- 1.28).  

CTP identify salvable tissue in acute stroke. Higher percentage of preserved at risk tissue is associated with better clinical outcome.  The futile recanalization is associated with lower percentage of penumbra saved.

This study helps us to determine the value of CT-Perfusion. Other parameters that may have clinical relevance are also being assessed (collateral, thrombus location .....). We are trying to obtain a predictive clinico-radiological scale to select patients who will benefit from reperfusion therapies.

Vicente Bartulos, A, Kawiorski ?, M, Lourido Garcia, D, Gorospe Sarasua, L, Muriel Garcia, A, Alonso de Lecinana Cases, M, CT Brain Perfusion (CTP): Do We Really is Useful in Ischemic Stroke?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14010347.html