Perfusion computed tomography in patients with stroke thrombolysis.

Area of Science:

• Neurology
• Radiology
• Public Health

Background:

• Stroke significantly impacts long-term disability and quality of life.
• Thrombolysis is a key treatment for acute ischemic stroke.
• Predicting long-term outcomes is crucial for patient management.

Purpose of the Study:

• To compare the prognostic value of pre- and post-treatment perfusion computed tomography (CT) imaging variables with clinical predictors for long-term stroke disability.
• To assess the impact of ischaemic core and penumbra volumes on disability-adjusted life-years (DALYs) in stroke patients.
• To determine if early onset-to-treatment time's benefit is mediated by penumbra salvage.

Main Methods:

• Analysis of data from 772 patients receiving intravenous alteplase for acute ischemic stroke.
• Utilized perfusion CT and CT angiography for baseline imaging and follow-up MRI to derive core/penumbra volumes and salvaged penumbra.
• Calculated DALYs based on clinical variables (age, sex, NIHSS, onset-to-treatment time) and imaging parameters.

Main Results:

• Each mL of baseline ischemic core volume lost 17.5 DALY days (P < 0.001).
• Each mL of salvaged penumbra saved 7.2 DALY days (P < 0.001).
• Earlier onset-to-treatment time saved 4.4 disability-free days per minute (P = 0.006), but this association was not significant after adjusting for imaging variables.

Conclusions:

• Pretreatment perfusion CT independently predicts significant gains or losses in disability-free life for stroke patients undergoing reperfusion therapy.
• The benefits of earlier treatment on disability-free life are primarily explained by the salvage of penumbra.
• Imaging variables, particularly penumbra salvage, are more influential than onset-to-treatment time in predicting long-term stroke outcomes.