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Author Notes:

Corresponding author: Name: Maarten G. Lansberg, MD PhD, Address: Stanford Stroke Center, 780 Welch Road, Suite 350, Palo Alto, CA 94304-5778, USA, lansberg@stanford.edu, Phone: +1 (650) 723-4448.

MGL, SK, MM, RB, MS, GZ, MM and GA conceived and designed the study.

MGL, SC, SK, MM, NM, CF, JPT, SK, RGN, TJ, TGD, NA, DRY, DH, SD, MPM, and GWA acquired and analyzed the data, and ML drafted the manuscript.

The CRISP study group is further composed of D. Thai (Stanford Medical Center, Stanford, CA); K. Armbruster and S. DeCesare (University of Pittsburgh Medical Center, Pittsburgh, PA); B. Brion (St. Luke’s Hospital, Kansas City, MO); K. Schindler, and L. Craft (Emory University, Atlanta, GA); K. Barton and T. Massengale (Chattanooga Center for Neurologic Research, Chattanooga, TN); and K. Ramdas (University of Miami, Miami, FL).

We appreciate the contributions of the members of the Data and Safety Monitoring board (Drs W. Smith, University of California at San Francisco (chair); J. English, California Pacific Medical Center; G. Howard, University of Alabama Birmingham; and Pina Sanelli, North Shore LIJ Health System).

S. Christensen receives consultant fees from iSchemaView which produces the software used in this trial for post-processing of CT perfusion studies.

T. Devlin received consulting fees and grant funding from Covidien/Medtronic which manufactures stent retrievers used to treat patients in this study.

D.R. Yavagal serves on the trial steering committee of Covidien/Medtronic and received consulting fees from Covidien/Medtronic.

T. Jovin received a research Grant from Stryker Neurovascular, consulting fees from Covidien/Medtronic, and payment for travel expenses from Stryker Neurovascular; all three companies manufacture stent retrievers used to treat patients in this study.

M.P. Marks received consulting fees from Covidien/Medtronic.

R.G. Nogueira received a research Grant from Stryker Neurovascular, serves on the Trial Exec. Committee for Penumbra, serves on the Trial Steering Committee for Covidien/Medtronic, and serves as the angiographic Core Lab for the STAR trial funded by Covidien/Medtronic; all three companies manufacture stent retrievers used to treat patients in this study.

G.W. Albers received consulting fees from Covidien/Medtronic. G.W. Albers, R. Bammer and M. Straka received consulting fees and are shareholders of iSchemaView, which produces the software used in this trial for post-processing of CT perfusion studies and they hold a patent related to that software.

None of the other authors (NA, CF, SD, DH, SK, SK, NM, MM, JT and GZ) have conflicts of interest.

Subject:

Research Funding:

The study was funded by two grants from the National Institute for Neurological Disorders and Stroke (NINDS, Principal Investigators Drs M. Lansberg and G. Albers).

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Clinical Neurology
  • Neurosciences
  • Neurosciences & Neurology
  • GENERALIZED ODDS RATIOS
  • ENDOVASCULAR TREATMENT
  • THROMBECTOMY
  • TIME
  • METAANALYSIS
  • REPERFUSION
  • MANAGEMENT
  • SELECTION
  • TRIAL

Computed Tomographic Perfusion to Predict Response to Recanalization in Ischemic Stroke

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Journal Title:

Annals of Neurology

Volume:

Volume 81, Number 6

Publisher:

, Pages 849-856

Type of Work:

Article | Post-print: After Peer Review

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.

Copyright information:

© 2017 American Neurological Association

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