Penumbra and re-canalization acute computed tomography in ischemic stroke evaluation: PRACTISE study protocol.

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Acute ischemic stroke requires timely treatment with intravenous thrombolysis.
• Current imaging protocols may not fully differentiate ischemic core from penumbra.
• Advanced imaging techniques offer potential for improved patient selection.

Purpose of the Study:

• To evaluate if multimodal computed tomography (CT) imaging increases intravenous thrombolysis rates in acute stroke patients.
• To assess the impact of multimodal CT on treatment outcomes.
• To compare multimodal CT with current standard imaging (NCCT alone).

Main Methods:

• Prospective, multicenter, randomized controlled trial (PRACTISE).
• 400 patients presenting within 4.5 hours of symptom onset randomized to NCCT alone or multimodal CT (NCCT + CT angiography + CT perfusion).
• Clinical decisions, imaging times, and treatment delivery times recorded; follow-up includes infarct size, edema, hemorrhage, NIHSS, and mRS scores.

Main Results:

• Primary outcome: proportion of patients receiving intravenous recombinant tissue plasminogen activator.
• Secondary outcomes: time to decision-making, comparison of imaging software, and 3-month functional outcomes.
• Data on the value of multimodal imaging in acute stroke treatment decisions will be provided.

Conclusions:

• Multimodal CT is a widely available tool for revascularization therapy selection.
• The study aims to determine the benefit of additional multimodal imaging in all acute stroke patients.
• Findings will inform treatment decisions for acute stroke management.