RT Journal Article
SR Electronic
T1 PO.12 Perfusion CT based thrombolysis in acute ischaemic stroke
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP e4
OP e4
DO 10.1136/jnnp-2011-300645.24
VO 82
IS 9
A1 Smriti Agarwal
A1 P S Jones
A1 D J Scoffings
A1 J Alawaneh
A1 P J Barry
A1 E W O'Brien
A1 E Carrera
A1 P E Cotter
A1 J C Baron
A1 E A Warburton
YR 2011
UL http://jnnp.bmj.com/content/82/9/e4.17.abstract
AB Background Despite use in clinical practice and trials of thrombolysis, a non-contrast CT is not sensitive for identifying penumbral tissue in acute stroke. This study evaluated how it compares with physiological imaging using CT perfusion.Methods 40 imaging datasets with non-contrast CT (NCCT) and perfusion CT (CTP) were retrospectively identified. 2 sets of observers (n=6) and a neuroradiologist made a blind evaluation of the images. Inter-observer agreement was calculated for identifying ischaemic change on NCCT, and abnormalities on cerebral blood flow, time to peak and cerebral blood volume maps. A prospective cohort of 73 patients with anterior circulation cortical strokes were thrombolysed based on qualitative assessment of penumbral tissue on CTP within 3 h of stroke onset. Functional outcome was assessed at 3 months.Results Inter-rater agreement was moderate (k=0.54) for early ischaemic change on NCCT. Perfusion maps improved this to substantial for deficit in cerebral blood volume (k=0.67) and almost perfect for time to peak and cerebral blood flow (both k=0.87). In the prospective arm, 58.9% of patients with cortical strokes were thrombolysed. There was no significant difference in attainment of complete recovery (p=0.184) between the thrombolysed and non-thrombolysed group.Conclusions We demonstrate how perfusion CT aids clinical decision-making in acute stroke. Good functional outcomes from thrombolysis can be safely achieved using this physiologically informed approach.