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Is CT perfusion helpful in the treatment allocation of patients with acute ischemic stroke? An expert-opinion

Laura Strada¹, Jonathan Y Streifler², Bruno Del Sette³

¹Neurology Unit.E.O. Ospedali Galliera, Via Mura delle Cappuccine 14, 16128, Genoa, Italy. laura.strada@galliera.it.

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology

|July 21, 2017

Abstract

Background:

Intravenous tPA is the standard treatment for acute ischemic stroke within 4.5 hours of symptom onset. Neuroradiological selection is currently based upon non-contrast- brain CT scan (NCCT).

Aims:

To verify, in an "expert-opinion setting", the possible usefulness of CT perfusion (CTP) in decision-making toward i.v. thrombolysis.

Patients And Method:

One hundred and three consecutive patients with acute ischemic stroke who underwent NCCT and CTP were re-evaluated by an expert in cerebrovascular disease, to verify if adding CTP information would have changed expert's opinion.

Results:

After CTP, a definitive decision was made for 20 more patients, changing the proportion of patients candidate to i.v. tPA from 44% to 51%, and reducing uncertainty from 29% to 10%. CTP results were useful inmilder stroke (p = 0.01).

Conclusions:

In a "real world" setting, CT perfusion could be useful for clinical decision, in particular for milder stroke.

Keywords:

ASPECT score Acute stroke CT scan Perfusion CT Thrombolysis

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