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Related Experiment Video

Updated: Feb 17, 2026

Improvement of a Closed Chest Porcine Myocardial Infarction Model by Standardization of Tissue and Blood Sampling Procedures
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Ischemic core thresholds change with time to reperfusion: A case control study.

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Thrombectomy for acute ischemic stroke salvages more tissue than alteplase alone, requiring a lower computed tomography perfusion threshold (relative cerebral blood flow <20%) to define the ischemic core. This finding suggests earlier reperfusion benefits tissue survival.

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Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Acute ischemic stroke management involves reperfusion therapies like thrombectomy and alteplase.
  • Accurate estimation of the ischemic core is crucial for predicting infarct volume and guiding treatment.

Purpose of the Study:

  • To determine if the computed tomography perfusion (CTP) ischemic core threshold differs between acute ischemic stroke patients treated with thrombectomy versus alteplase, both achieving complete reperfusion.
  • To identify optimal CTP thresholds for defining the ischemic core in thrombectomy patients compared to alteplase-treated patients.

Main Methods:

  • Matched cohort study comparing 132 thrombectomy patients with 132 alteplase-treated patients from the International Stroke Perfusion Imaging Registry.
  • Pixel-based analysis of coregistered pretreatment CTP and 24-hour diffusion-weighted imaging (DWI) to define optimal ischemic core thresholds.
  • Comparison of baseline characteristics including National Institutes of Health Stroke Scale, age, and time to treatment.

Main Results:

  • Thrombectomy patients had a smaller median 24-hour infarct core (17.3ml) compared to alteplase-treated controls (24.3ml) despite similar baseline ischemic core volumes (rCBF <30%).
  • The optimal CTP threshold for defining the ischemic core in thrombectomy patients was identified as relative cerebral blood flow (rCBF) <20%.
  • The optimal ischemic core threshold for alteplase-treated controls remained rCBF <30%.

Conclusions:

  • Thrombectomy effectively salvages brain tissue with lower baseline relative cerebral blood flow, likely due to earlier reperfusion.
  • A stricter rCBF threshold (<20%) should be considered for estimating the ischemic core in acute ischemic stroke patients undergoing thrombectomy with rapid reperfusion.
  • These findings have implications for refining imaging biomarkers in stroke treatment selection and outcome prediction.