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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Perfusion CT for selecting patients with acute ischemic stroke for intravenous thrombolytic therapy
Kirsteen R Burton1, Deljit Dhanoa, Richard I Aviv
1From the Institute for Health Policy, Management and Evaluation (K.R.B., M.K.K., A.L.), Department of Medical Imaging (K.R.B., R.I.A., A.R.M.), Institute of Medical Sciences (R.I.A., A.R.M.), and Department of Medicine (M.K.K., A.L.), University of Toronto, 263 McCaul St, 4th Floor, Toronto, ON, Canada M5T 1W7; Department of Medical Imaging, Fraser Health Authority, Vancouver, British Columbia, Canada (D.D.); Department of Medical Imaging, University of British Columbia, Vancouver, British Columbia, Canada (D.D.); Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (M.K.K.); and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada (A.L.).
Insights
Perfusion CT (computed tomography) helps select acute ischemic stroke patients for thrombolytic therapy. Outcomes appear favorable, especially when treatment begins more than 3 hours after symptom onset, with lower mortality and better functional recovery.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Medicine
Background:
- Acute ischemic stroke requires timely reperfusion therapy.
- Perfusion imaging techniques like CT can optimize patient selection for thrombolysis.
- Evaluating outcomes in patients selected by perfusion CT is crucial for treatment guidelines.
Purpose of the Study:
- To determine mortality, disability, and symptomatic intracranial hemorrhage (SICH) rates in acute ischemic stroke patients.
- To assess outcomes for patients selected using perfusion CT for thrombolytic therapy.
- To conduct a systematic review and meta-analysis of relevant studies.
Main Methods:
- Systematic literature search up to July 2012 using multiple databases (MEDLINE, EMBASE, PubMed, etc.).
- Inclusion of experimental or observational studies on patients receiving thrombolytic treatment after perfusion CT.
- Extraction of study data and assessment of bias by two independent reviewers.
Main Results:
- Thirteen studies involving patients treated with intravenous thrombolysis post-perfusion CT were identified.
- Overall 90-day mortality was 10.0%.
- Patients treated >3 hours after symptom onset showed lower mortality (2.9%) and higher favorable outcomes (69.9%) compared to those treated within 3 hours.
Conclusions:
- Perfusion CT is a valuable tool for selecting acute ischemic stroke patients for thrombolytic therapy.
- Treatment initiated more than 3 hours after symptom onset, when selected by perfusion CT, demonstrates favorable outcomes.
- The study supports the use of perfusion CT to guide thrombolytic treatment decisions in stroke care.
Purpose:
To determine rates of death, disability, and symptomatic intracranial hemorrhage ( SICH symptomatic ICH ) among patients with acute ischemic stroke selected for thrombolytic therapy by using perfusion computed tomography (CT) by conducting a systematic review and meta-analysis.
Materials And Methods:
A search of the literature up to July 2012 was performed by using MEDLINE, EMBASE, the Cochrane Library, PubMed, and Google Scholar on terms including "brain ischemia" and "perfusion imaging." The search was unrestricted by language of publication. Two reviewers extracted study data and independently assessed the risk of study bias. Outcomes of patients selected by using perfusion CT, including case-fatality rate, favorable outcome (modified Rankin Scale [ mRS modified Rankin Scale ] score, ≤2), and rates of SICH symptomatic ICH , were estimated.
Results:
Thirteen experimental or observational studies that included patients who received intravenous thrombolytic treatment after perfusion CT were identified. The methodologic quality of the small studies was generally good. Overall, 90-day mortality was 10.0% (95% confidence interval [ CI confidence interval ]: 5.4%, 15.9%). Among patients treated within 3 hours of symptom onset, mortality was 12.5% (95% CI confidence interval : 6.7%, 19.7%), a favorable outcome ( mRS modified Rankin Scale score, ≤2) was seen in 42.5% of patients (95% CI confidence interval : 16.6%, 70.9%), and the SICH symptomatic ICH rate was 3.3% (95% CI confidence interval : 0.7%, 7.7%). Among patients treated more than 3 hours after symptom onset, mortality was 2.9% (95% CI confidence interval : 0.0%, 12.7%), 69.9% of patients (95% CI confidence interval : 0%, 83.5%) had a favorable outcome, and the SICH symptomatic ICH rate was 3.9% (95% CI confidence interval : 0.8%, 9.2%).
Conclusion:
The outcomes (mortality, morbidity, and SICH symptomatic ICH rates) for patients selected with perfusion CT to receive intravenous thrombolytic treatment more than 3 hours after symptom onset appear favorable.
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