Related Experiment Video
Updated: Jul 7, 2026
13:16
Intravascular Perfusion of Carbon Black Ink Allows Reliable Visualization of Cerebral Vessels
Published on: January 4, 2013
16.0K
The Ghost Penumbra Pattern in Acute Ischemic Stroke: Characterization and Prognostic Significance
Mercedes de Lera Alfonso1, Alicia Sierra-Gómez1, Ana I Calleja1
1Stroke Program, Department of Neurology, Hospital Clínico Universitario De Valladolid (HCUV), Instituto De Investigación Biomédica De Valladolid (IBIOVALL), Valladolid, Spain.
Summary
The ghost penumbra pattern (GPP) was found in 58% of acute ischemic stroke patients treated with endovascular therapy. This pattern, indicating an underestimation of stroke core volume, was associated with better collateral circulation and safe reperfusion.
Area of Science:
- Neuroradiology
- Stroke Imaging
- Cerebrovascular Diseases
Background:
- The ghost penumbra pattern (GPP) on computed tomography perfusion (CTP) can underestimate ischemic core volume compared to noncontrast CT (NCCT).
- Understanding GPP frequency and influencing factors is crucial for acute ischemic stroke (AIS) management.
Purpose of the Study:
- To determine the frequency of GPP in AIS patients undergoing endovascular therapy (EVT).
- To identify baseline factors associated with GPP.
- To evaluate the impact of GPP on clinical and radiological outcomes after EVT.
Main Methods:
- Analysis of NCCT, multiphase CT angiography (CTA), and CTP in 173 AIS patients with large vessel occlusion treated with EVT.
- GPP defined as a CT core/CTP core ratio >1.5.
- Assessment of collateral status, thrombus migration, parenchymal hematoma, hypodensity, and functional outcomes (modified Rankin Scale at 90 days).
Main Results:
- GPP was detected in 100 (58%) patients.
- Good collateral circulation (OR 2.8) and lower NIHSS scores (OR 0.9) were independently associated with GPP.
- GPP predicted a lower risk of parenchymal hematoma (OR 0.43).
Conclusions:
- GPP is common in AIS patients treated with EVT, occurring in approximately half of cases.
- GPP is linked to favorable collateral status and thrombus migration.
- Endovascular reperfusion is safe in patients with GPP.
Related Concept Videos
01:15Ischemic Stroke l: Introduction
Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
01:15Ischemic Stroke ll: Pathophysiology
An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
01:17Hemorrhagic Stroke l: Introduction
A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
01:29Hemorrhagic Stroke ll: Pathophysiology
A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
01:26Transient Ischemic Attack l: Introduction
A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...