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Computed tomography perfusion (CTP) is a widely used imaging technique for acute stroke
.
Although the scan time increases, the CTP post-processing algorithm is also very different, which may cause treatment delays, sensitivity to patient movement, additional radiation and contrast doses, and additional treatment costs.
Stroke blood clot
For patients with an advanced time window, that is, patients whose symptoms appear more than 6 hours after the onset of symptoms, CTP is considered to be the standard treatment method because of DAWN (Clinical Mismatch in the Trivo Triage of Wake Up and Late Presenting Strokes Undergoing Neurointervention With Trevo) and DEFUSE-3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3) These two late time window EVT trials both use perfusion imaging to select patients
.
However, the added value of CTP in the early time window (0-6 hours) is still uncertain
.
According to current treatment guidelines , perfusion imaging is not required for EVT decisions in the early time window, but in many centers, it is still performed as part of the diagnostic work
Guide Diagnosis
In this way, Ashutosh P.
Jadhav and others in the United States conducted a sub-analysis of patients with LVO in the early time window of HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) to determine the relationship between baseline CTP imaging and clinical results, and compared Results of patients who used simple baseline imaging protocols (non-contrast CT and CT angiography) and patients who received additional CTP imaging
.
HERMES compiled patient-level data from randomized controlled trials to compare EVT and routine care for acute ischemic stroke caused by anterior circulation and great vessel occlusion
.
In randomized patients with CTP baseline imaging and without CTP baseline imaging, good functional results were compared, defined as a modified Rankin scale score of 0 to 2 at 90 days
.
Univariate and multivariate binary logistic regression analysis were performed to determine the relationship between baseline CTP imaging and good functional outcome
They analyzed 1,348 patients, of which 610 (45.
3%) received CTP before randomization
.
Compared with the best medical management , regardless of the baseline imaging mode, the benefits of EVT are maintained (EVT and control group patients' 90-day modified Rankin scale score 0-2: with CTP: 46.
manage
Compared with baseline non-contrast CT and CT angiography, performing CTP baseline angiography only produces a similar good result rate (odds ratio, 1.
05 [95% CI, 0.
82-1.
33], adjusted odds ratio, 1.
04, [95% CI , 0.
80-1.
35])
.
The important significance of this study is that it found that in patients with or without CTP, the good functional outcome rate is similar .
Within a time window of 0-6 hours, the effect of EVT treatment is in patients with and without baseline CTP imaging.
China is similar
.
Original source:
Jadhav AP, Goyal M, Ospel J, et al.
Thrombectomy With and Without Computed Tomography Perfusion Imaging in the Early Time Window: A Pooled Analysis of Patient-Level Data.
Stroke.
Thrombectomy With and Without Computed Tomography Perfusion Imaging in the Early Time Window: A Pooled Analysis of Patient-Level Data.
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