Computed tomographic perfusion to Predict Response to Recanalization in ischemic stroke

for the CT Perfusion to Predict Response to Recanalization in Ischemic Stroke Project (CRISP) Investigators

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Objective: To assess the utility of computed tomographic (CT) perfusion for selection of patients for endovascular therapy up to 18 hours after symptom onset. Methods: 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. Results: 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). Interpretation: 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.

Original languageEnglish (US)
Pages (from-to)849-856
Number of pages8
JournalAnnals of Neurology
Volume81
Issue number6
DOIs
StatePublished - Jun 1 2017

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Perfusion
Stroke
Reperfusion
Odds Ratio
Confidence Intervals
Therapeutics
Patient Selection
Multicenter Studies
Angiography
Cohort Studies
Magnetic Resonance Imaging
Population

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

for the CT Perfusion to Predict Response to Recanalization in Ischemic Stroke Project (CRISP) Investigators (2017). Computed tomographic perfusion to Predict Response to Recanalization in ischemic stroke. Annals of Neurology, 81(6), 849-856. https://doi.org/10.1002/ana.24953

Computed tomographic perfusion to Predict Response to Recanalization in ischemic stroke. / for the CT Perfusion to Predict Response to Recanalization in Ischemic Stroke Project (CRISP) Investigators.

In: Annals of Neurology, Vol. 81, No. 6, 01.06.2017, p. 849-856.

Research output: Contribution to journalArticle

for the CT Perfusion to Predict Response to Recanalization in Ischemic Stroke Project (CRISP) Investigators 2017, 'Computed tomographic perfusion to Predict Response to Recanalization in ischemic stroke', Annals of Neurology, vol. 81, no. 6, pp. 849-856. https://doi.org/10.1002/ana.24953
for the CT Perfusion to Predict Response to Recanalization in Ischemic Stroke Project (CRISP) Investigators. Computed tomographic perfusion to Predict Response to Recanalization in ischemic stroke. Annals of Neurology. 2017 Jun 1;81(6):849-856. https://doi.org/10.1002/ana.24953
for the CT Perfusion to Predict Response to Recanalization in Ischemic Stroke Project (CRISP) Investigators. / Computed tomographic perfusion to Predict Response to Recanalization in ischemic stroke. In: Annals of Neurology. 2017 ; Vol. 81, No. 6. pp. 849-856.
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abstract = "Objective: To assess the utility of computed tomographic (CT) perfusion for selection of patients for endovascular therapy up to 18 hours after symptom onset. Methods: 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. Results: 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). Interpretation: 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.",
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AU - for the CT Perfusion to Predict Response to Recanalization in Ischemic Stroke Project (CRISP) Investigators

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AU - Christensen, Soren

AU - Kemp, Stephanie

AU - Mlynash, Michael

AU - Mishra, Nishant

AU - Federau, Christian

AU - Tsai, Jenny P.

AU - Kim, Sun

AU - Nogueria, Raul G.

AU - Jovin, Tudor

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AU - Haussen, Diogo

AU - Dehkharghani, Seena

AU - Bammer, Roland

AU - Straka, Matus

AU - Zaharchuk, Greg

AU - Marks, Michael P.

AU - Albers, Gregory W.

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N2 - Objective: To assess the utility of computed tomographic (CT) perfusion for selection of patients for endovascular therapy up to 18 hours after symptom onset. Methods: 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. Results: 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). Interpretation: 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.

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