Abstract

To assess the utility of computed tomographic (CT) perfusion for selection of patients for endovascular therapy up to 18 hours after symptom onset.We conducted a multicenter cohort study of consecutive acute stroke patients scheduled to undergo endovascular therapy within 90 minutes after a baseline CT perfusion. Patients were classified as "target mismatch" if they had a small ischemic core and a large penumbra on their baseline CT perfusion. Reperfusion was defined as >50% reduction in critical hypoperfusion between the baseline CT perfusion and the 36-hour follow-up magnetic resonance imaging.Of the 201 patients enrolled, 190 patients with an adequate baseline CT perfusion study who underwent angiography were included (mean age?=?66 years, median NIH Stroke Scale [NIHSS]?=?16, median time from symptom onset to endovascular therapy?=?5.2 hours). Rate of reperfusion was 89%. In patients with target mismatch (n?=?131), reperfusion was associated with higher odds of favorable clinical response, defined as an improvement of =8 points on the NIHSS (83% vs 44%; p?=?0.002, adjusted odds ratio [OR]?=?6.6, 95% confidence interval [CI]?=?2.1-20.9). This association did not differ between patients treated within 6 hours (OR?=?6.4, 95% CI?=?1.5-27.8) and those treated?>?6 hours after symptom onset (OR?=?13.7, 95% CI?=?1.4-140).The robust association between endovascular reperfusion and good outcome among patients with the CT perfusion target mismatch profile treated up to 18 hours after symptom onset supports a randomized trial of endovascular therapy in this patient population. Ann Neurol 2017;81:849-856.

View details for DOI 10.1002/ana.24953

View details for PubMedID 28486789