Evaluation of perfusion CT and TIBI grade in acute stroke for predicting thrombolysis benefit and clinical outcome

Article Article scientifique Article Evaluation of perfusion CT and TIBI grade in acute stroke for predicting thrombolysis benefit and clinical outcome eng 2009 author Knoepfli Anne-Sophie 503155 author Sekoranja Lucka 504644 author Bonvin Christophe 680301 author Delavelle Jacqueline 526549 author Kulcsar Zsolt 724585 author Ruefenacht Daniel André 28650 author Yilmaz Hasan 565252 author Sztajzel Roman 30504 author Altrichter S. author Lövblad Karl-Olof 135154 131-137 10.1016/j.neurad.2008.10.003 19062093 0150-9861 OBJECTIVE: To evaluate the prognostic accuracy of combining perfusion CT (PCT) and thrombolysis in brain ischemia (TIBI) ultrasonographic grade in the triage of stroke patients who will benefit from thrombolysis and in predicting the clinical outcome. METHODS: We conducted a prospective study of all consecutive stroke patients admitted to our hospital from March 2003 to July 2007, presenting with signs of acute stroke within the therapeutic window, who had undergone either intravenous or combined intravenous and intra-arterial thrombolysis. All patients were evaluated by a complete stroke CT protocol, transcranial color-coded duplex sonographic monitoring, follow-up imaging (CT or MRI) and clinical outcome at 3 months, as assessed by the modified Rankin scale (mRS). RESULTS: A total of 34 patients were included with a mean NIHSS on admission of 14.2. This study revealed that PCT had 95% sensitivity and 71% specificity in the evaluation of therapy benefit as well as 75% sensitivity and 39% specificity in predicting clinical outcome. The extent of ischemic tissue according to PCT and TIBI grade were significantly correlated (p<0.05). Using the MTT-TTP approach was an alternative to the classical MTT-CBV approach for determining tissue at risk. The clinical outcome assessed by the mRS was considered favorable (mRS 0-2) in 16 patients and unfavorable (mRS>2) in 18 patients. CONCLUSION: PCT was the most accurate predictor of both thrombolytic therapy benefit and clinical outcome. The TIBI score was useful for determining whether or not to perform intravenous therapy alone or as a combined therapy. Adult Aged Aged, 80 and over Brain Ischemia/complications/*diagnosis/*therapy Cerebrovascular Circulation Cohort Studies Female Humans Male Middle Aged *Perfusion Imaging Predictive Value of Tests Stroke/*diagnosis/etiology/therapy *Thrombolytic Therapy *Tomography, X-Ray Computed Treatment Outcome Ultrasonography, Doppler, Transcranial Dewey 616.0757 Dewey 616.8 61 Département des neurosciences cliniques 226 62 Département de radiologie et informatique médicale 227 false 470 Ischémie cérébrale et connectivité 801 Journal of neuroradiology 36 3 Faculté de médecine / Section de médecine clinique / Département des neurosciences cliniques Faculté de médecine / Section de médecine clinique / Département de radiologie et informatique médicale

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Evaluation of perfusion CT and TIBI grade in acute stroke for predicting thrombolysis benefit and clinical outcome	Journal of neuroradiology			2009	695	0

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Knoepfli, Anne-Sophie