Hypoperfusion ratio predicts infarct growth during transfer for thrombectomy

Ann Neurol. 2018 Oct;84(4):616-620. doi: 10.1002/ana.25320. Epub 2018 Sep 23.

Abstract

We hypothesized that automated assessment of collaterals on computed tomography perfusion can predict the rate of infarct growth during transfer from a primary to a comprehensive stroke center for endovascular stroke treatment. We identified consecutive patients (N = 28) and assessed their collaterals based on the hypoperfusion intensity ratio (HIR) prior to transfer. Infarct growth rate was strongly correlated with HIR (r = 0.78, p < 0.001). Receiver operating characteristic analysis identified HIR ≥ 0.5 as optimal for predicting infarct growth. Patients with HIR ≥ 0.5 had a median infarct growth rate of 10.1ml/h (interquartile range [IQR] = 6.4-18.4) compared with 0.9ml/h (IQR = 0-2.8; p < 0.001) in patients with HIR < 0.5. Patients with HIR ≥ 0.5 had an 83% probability of significant core growth, whereas patients with HIR < 0.5 had an 88% probability of core stability. These preliminary data have the potential to guide decision making regarding whether repeat brain imaging should be performed after transfer to a comprehensive stroke center. Ann Neurol 2018;84:616-620.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain Infarction / diagnostic imaging*
  • Brain Infarction / surgery*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Transfer / methods*
  • Patient Transfer / trends
  • Perfusion Imaging / methods*
  • Perfusion Imaging / trends
  • Predictive Value of Tests
  • Retrospective Studies
  • Thrombectomy / methods*
  • Thrombectomy / trends
  • Tomography, X-Ray Computed / methods*
  • Tomography, X-Ray Computed / trends