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Published on: February 17, 2013
CT Perfusion as a Selection Tool for Mechanical Thrombectomy, a Single-Centre Study
Emilie De Muynck1, Vincent Huybrechts1, Dimitri Hemelsoet2
1Master Students Medical Sciences, UGent University, BE.
Insights
CT perfusion (CTP) did not significantly improve functional outcomes for stroke patients undergoing mechanical thrombectomy. Shorter procedure times were associated with better outcomes, highlighting the importance of efficiency in endovascular treatment.
Area of Science:
- Neurology
- Interventional Radiology
- Stroke Medicine
Background:
- CT perfusion (CTP) is a proposed selection tool for endovascular thrombectomy in stroke patients.
- Investigated functional outcome improvement after CTP introduction.
Purpose of the Study:
- To evaluate if CTP improves functional outcomes in anterior circulation stroke patients undergoing mechanical thrombectomy.
- Compare outcomes pre- and post-CTP introduction.
Main Methods:
- Retrospective single-center study of 89 patients with anterior circulation major vessel occlusion.
- Included patients who received CTP and mechanical thrombectomy (2014-2015).
- Visual CTP evaluation, analysis of demographics, stroke/time data, procedural data, and functional outcomes (mRS).
Main Results:
- At 3 months, 48.4% achieved good functional outcome (mRS 0-2) and 34.4% excellent functional outcome (mRS 0-1).
- Mortality rate at 3 months was 14.5%.
- Outcome improvement with CTP was not statistically significant compared to a pre-CTP era study.
Conclusions:
- Mechanical thrombectomy for anterior circulation strokes guided by CTP did not significantly improve functional outcomes.
- Procedure duration was the only time-interval associated with improved functional outcome.
Background:
Recently, CT perfusion (CTP) has been proposed as a selection tool for stroke patients to be treated with endovascular thrombectomy. We investigated whether functional outcome following endovascular treatment was improved after the introduction of CTP.
Methods:
This retrospective single-centre study includes all patients with a major vessel occlusion in the anterior circulation that received a CTP and underwent a mechanical thrombectomy from 2014 up to 2015. CTP were visually evaluated. Demographics, stroke and time data, procedural data, functional outcomes as measured by the modified Rankin Scale (mRS) and the association between these variables were studied. A comparison was made with the results of a similar local retrospective study from before the CTP "era".
Results:
Eighty-nine patients were included in this study. Median National Institutes of Health Stroke Scale (NIHSS) was 16 (Interquartile range 6). At three months, good functional outcome (GFO; mRS 0-2) was achieved in 48.4% and excellent functional outcome (EFO; mRS 0-1) in 34.4% of patients. The mortality rate at three months was 14.5%. GFO at one year was 44.8%, EFO was 31.3% and mortality 21.1%. The duration of the thrombectomy procedure and the EFO were associated (p = 0.032). The outcome improvement achieved with CTP was higher compared to the reference study (GFO 48.4% versus 44%; EFO 34.4% versus 29%) but remained below the statistical significance.
Conclusions:
Mechanical thrombectomy for anterior circulation strokes based on CTP did not result in a significant functional outcome improvement. The duration of the thrombectomy procedure was the sole time-interval related to improved functional outcome.
