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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

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Published on: January 18, 2018

Ischemic stroke in evolution: predictive value of perfusion computed tomography.

Amir Kheradmand¹, Marc Fisher², David Paydarfar²

¹Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association

|August 20, 2013

Summary

Time to peak (TTP) is a better predictor of infarct in acute stroke patients than mean transit time (MTT) perfusion computed tomography (PCT) parameters. The MTT/TTP mismatch indicates collateral blood supply to at-risk tissue.

Keywords:

Computed tomography mean transit time perfusion stroke time to peak

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Published on: December 28, 2014

Area of Science:

Neurology
Radiology
Medical Imaging

Background:

Perfusion computed tomography (PCT) parameters are utilized to identify tissue at risk of infarction in acute stroke.
Accurate identification of the ischemic penumbra is crucial for treatment decisions.
This study excluded thrombolysis effects to focus on inherent PCT parameter predictive value.

Purpose of the Study:

To evaluate the predictive value of commonly used PCT parameters for defining the ischemic penumbra in acute stroke.
To compare the accuracy of Mean Transit Time (MTT) and Time to Peak (TTP) in predicting final infarct size.
To assess the relationship between PCT parameters and collateral blood supply.

Main Methods:

18 acute stroke patients not receiving thrombolysis underwent PCT and CT angiogram (CTA).
PCT images were processed using a delay-sensitive deconvolution algorithm.
Lesion sizes from MTT, TTP, cerebral blood flow, and cerebral blood volume maps were correlated with final infarct size determined by follow-up imaging. Collateral supply was graded using CTA.

Main Results:

Mean Transit Time (MTT) lesions were significantly larger than final infarcts (P < .05).
Time to Peak (TTP) showed a stronger correlation with infarct size (r = .95) compared to MTT (r = .66) (P = .004).

Conclusions:

Standard MTT thresholds overestimate the ischemic penumbra in acute stroke.
TTP, with an appropriate threshold, is a more reliable predictor of infarct extent.
The mismatch between MTT and TTP reflects the status of collateral circulation to the brain tissue at risk.