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Ann Neurol. 2016 Jan;79(1):76-89. doi: 10.1002/ana.24543. Epub 2015 Dec 12.

Ischemic core and hypoperfusion volumes predict infarct size in SWIFT PRIME.

Author information

1
Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA.
2
Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
3
Division of Interventional Neuroradiology, University of California, Los Angeles, Los Angeles, CA.
4
Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier, France.
5
Department of Neurology, Duisburg-Essen University Hospital, Essen, Germany.
6
Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY.
7
Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
8
Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France.
9
Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City School of Medicine, Kansas City, MO.
10
Department of Neurology, University of Heidelberg, Heidelberg, Germany.
11
Department of Radiology and Neuroradiology, Christian Albrechts University of Kiel, Kiel, Germany.
12
Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA.
13
Department of Neurology, Inselspital, University of Bern, Bern, Switzerland.
14
Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Department of Neurology, Emory University School of Medicine, Atlanta, GA.
15
Department of Neurosurgery, Toshiba Stroke and Vascular Research Center, State University of New York at Buffalo, Buffalo, NY.
16
Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL.
17
Department of Radiology, Erlanger Hospital at University of Tennessee, Chattanooga, TN.
18
Division of Neurology, Erlanger Hospital at University of Tennessee, Chattanooga, TN.
19
Department of Neurosurgery, Rush University Medical Center, Chicago, IL.
20
Institute of Neuroradiology, Goethe University Hospital, Frankfurt, Germany.
21
Department of Neurology, Goethe University Hospital, Frankfurt, Germany.
22
Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA.

Abstract

OBJECTIVE:

Within the context of a prospective randomized trial (SWIFT PRIME), we assessed whether early imaging of stroke patients, primarily with computed tomography (CT) perfusion, can estimate the size of the irreversibly injured ischemic core and the volume of critically hypoperfused tissue. We also evaluated the accuracy of ischemic core and hypoperfusion volumes for predicting infarct volume in patients with the target mismatch profile.

METHODS:

Baseline ischemic core and hypoperfusion volumes were assessed prior to randomized treatment with intravenous (IV) tissue plasminogen activator (tPA) alone versus IV tPA + endovascular therapy (Solitaire stent-retriever) using RAPID automated postprocessing software. Reperfusion was assessed with angiographic Thrombolysis in Cerebral Infarction scores at the end of the procedure (endovascular group) and Tmax > 6-second volumes at 27 hours (both groups). Infarct volume was assessed at 27 hours on noncontrast CT or magnetic resonance imaging (MRI).

RESULTS:

A total of 151 patients with baseline imaging with CT perfusion (79%) or multimodal MRI (21%) were included. The median baseline ischemic core volume was 6 ml (interquartile range= 0-16). Ischemic core volumes correlated with 27-hour infarct volumes in patients who achieved reperfusion (r = 0.58, p < 0.0001). In patients who did not reperfuse (<10% reperfusion), baseline Tmax > 6-second lesion volumes correlated with 27-hour infarct volume (r = 0.78, p = 0.005). In target mismatch patients, the union of baseline core and early follow-up Tmax > 6-second volume (ie, predicted infarct volume) correlated with the 27-hour infarct volume (r = 0.73, p < 0.0001); the median absolute difference between the observed and predicted volume was 13 ml.

INTERPRETATION:

Ischemic core and hypoperfusion volumes, obtained primarily from CT perfusion scans, predict 27-hour infarct volume in acute stroke patients who were treated with reperfusion therapies.

PMID:
26476022
DOI:
10.1002/ana.24543
[Indexed for MEDLINE]

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