Computed tomographic perfusion to Predict Response to Recanalization in ischemic stroke.

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Acute ischemic stroke requires timely reperfusion therapy.
• Endovascular therapy is a key treatment for select stroke patients.
• Accurate patient selection is crucial for optimizing endovascular therapy outcomes.

Purpose of the Study:

• To evaluate the effectiveness of computed tomographic (CT) perfusion imaging in selecting patients for endovascular therapy.
• To determine if CT perfusion can identify patients who benefit from treatment up to 18 hours after stroke symptom onset.

Main Methods:

• A multicenter cohort study included acute stroke patients undergoing endovascular therapy.
• Patients were assessed using baseline CT perfusion to identify a "target mismatch" profile (small core, large penumbra).
• Reperfusion was confirmed by follow-up imaging, and clinical outcomes were evaluated based on NIH Stroke Scale (NIHSS) improvement.

Main Results:

• Out of 190 included patients, 89% achieved reperfusion.
• Patients with the CT perfusion "target mismatch" profile showed significantly higher rates of favorable clinical response (83% vs. 44%).
• This association between reperfusion and favorable outcome was consistent in patients treated within 6 hours and those treated after 6 hours.

Conclusions:

• CT perfusion's "target mismatch" profile is robustly associated with good outcomes after endovascular reperfusion in stroke patients treated up to 18 hours.
• These findings support conducting a randomized trial for endovascular therapy in this extended time window.
• CT perfusion is a valuable tool for patient selection in late-window stroke treatment.