Evolution pattern estimated by computed tomography perfusion post-thrombectomy predicts outcome in acute ischemic stroke

• Published in: Journal of stroke and cerebrovascular diseases Vol. 33; no. 4; p. 107555
• Main Authors: Dai, Xinyu, Yan, Chuming, Yu, Fan, Li, Qiuxuan, Lu, Yao, Shan, Yi, Zhang, Miao, Guo, Daode, Bai, Xuesong, Jiao, Liqun, Ma, Qingfeng, Lu, Jie
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2024
• Subjects: Acute ischemic stroke; Brain Ischemia - diagnostic imaging; Brain Ischemia - therapy; Computed Tomography Angiography - methods; Endovascular Procedures - adverse effects; Endovascular Procedures - methods; Endovascular thrombectomy; Humans; Ischemic Stroke - diagnostic imaging; Ischemic Stroke - surgery; Perfusion; Reperfusion; Retrospective Studies; Stroke - diagnostic imaging; Stroke - surgery; Thrombectomy - adverse effects; Thrombectomy - methods; Tomography; Treatment Outcome; Tomography; Endovascular thrombectomy; Reperfusion; Acute ischemic stroke
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2024.107555

Computed tomography perfusion (CTP) and computed tomography angiography (CTA) have been recommended to select acute ischemic stroke (AIS) patients for endovascular thrombectomy (EVT) but are not widely used for post-treatment evaluation. We aimed to observe abnormalities in CTP and CTA before and after EVT and evaluate post-EVT CTP and CTA as potential tools for improving clinical outcome prediction. Patients with AIS who underwent EVT and received CTP and CTA before and after EVT were retrospectively evaluated. The ischemic core was defined as the volume of relative cerebral blood flow <30% and hypoperfusion as the volume of Tmax >6 s. A reduction in hypoperfusion volume >90% between baseline and post-EVT CTP was defined as tissue optimal reperfusion (TOR). The 90-day modified Rankin scale was used to evaluate the clinical outcome. Eighty-three patients were included. Patients with an absent ischemic core or with TOR after EVT had a higher rate of modified Thrombolysis in Cerebral Ischemia score 2c-3 and recanalization of post-treatment vessel condition based on follow-up CTA. Multivariable logistic regression revealed that the baseline ischemic core volume (OR:0.934, p=0.009), TOR (OR:8.322, p=0.029) and immediate NIHSS score after EVT (OR:0.761, p=0.012) were factors significantly associated with good clinical outcome. Combining baseline ischemic core volume and TOR with immediate NIHSS score after EVT showed greatest performance for good outcome prediction after EVT(AUC=0.921). The addition of pretreatment and post-treatment CTP information to purely clinical NIHSS scores might help to improve the efficacy for good outcome prediction after EVT.