Computed Tomography Perfusion Maps and Final Infarction with Hyper-acute Stroke Patients Who Achieved Catheter Thrombolysis Therapy

Computed Tomography Perfusion Maps and Final Infarction with Hyper-acute Stroke Patients Who Achieved Catheter Thrombolysis Therapy

Naito Yukari
Published: European Neurology - Volume 3 Issue 2
US Neurology - Volume 4 Issue 2
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The Cerebral Stroke Centre at Wakakusa Daiichi Hospital in Japan used computed tomography perfusion (CTP) to select candidates for catheter thrombolysis therapy from June 2002 to June 2005, until the treatment guidelines, which were for thrombolysis therapy by intravenous administration of recombinant tissue-type plasminogen activator (alteplase) for hyper-acute cerebral stroke patients, were established by the Japan Stroke Society.1,2 No previous study in Japan had investigated the correlation between the pre-treatment CTP maps and the outcome after intra-arterial catheter thrombolysis therapy with hyper-acute stroke patients. Lev et al. described a correlation between cerebral perfusion volume reduction area and a final infarction lesion after catheter thrombolysis therapy in a perfusion-weighted CT study of hyper-acute cerebral stroke cases.3 However, they did not include an investigation of mean transit time (MTT) in the study. Eastwood et al. reported that prolonged MTT areas are larger than cerebral blood flow (CBF) and cerebral blood volume (CBV) reduction areas.4,5 The collateral vessels have been reported to influence MTT.4 Prolonged MTT areas with the box-modified transfer function (box-MTF) method (deconvolution analysis CTP software) are known to include a tracer delay developed to circulate a roundabout route of collateral vessels.6,7 In the current study, relationships between the location and site of the prolonged MTT areas as pre-treatment states and final infarction areas afterintra-arterial catheter thrombolysis therapy with hyper-acute stroke patients were investigated using box-MTF analysis software. We also included evaluations of CBF and CBV reduction areas, collateral vessel development based on findings of CT angiography (CTA), outcome of thrombolysis therapy, presence of haemorrhage as a complication after therapy and patient outcome after catheter thrombolysis.

Materials and Methods
Plain CT, CTP and CTA were performed on 22 hyper-acute stroke patients who were brought to the emergency room of Wakakusa Daiichi Hospital within six hours of onset. All 22 patients with ischaemic lesions were treated immediately with catheter thrombolysis after the CTP study. The occlusion vessels and collateral vessels were confirmed by CTA. Follow-up CT was performed to examine the presence of the final infarction after thrombolysis (see Figure 1). Image acquisition was performed according to the methods and scanning technique described by Yukari et al.8

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