Imaging Triage of Patients with Late-Window (6-24 Hours) Acute Ischemic Stroke: A Comparative Study Using Multiphase CT Angiography versus CT Perfusion INTERVENTIONAL

CONCLUSIONS: The collateral-based imaging paradigm using multiphase CTA compares well with CTP in selecting patients for endovascular thrombectomy in the late time window.
Source: American Journal of Neuroradiology - Category: Radiology Authors: Tags: INTERVENTIONAL Source Type: research

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Objective: To explore the value of whole-brain perfusion parameters combined with multiphase computed tomography angiography (MP-CTA) in predicting the hemorrhagic transformation (HT) of ischemic stroke. Methods: A total of 64 patients with ischemic stroke who underwent noncontrast computed tomography, computed tomography perfusion imaging, and computed tomography angiography before treatment from August 2017 to June 2019 were included retrospectively. The perfusion parameters cerebral blood volume (CBV), cerebral blood flow (CBF), time to peak (TTP), mean transit time (MTT), time to maximum (Tmax), and permeability surfac...
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Source Type: research
CONCLUSION: A high level of CEUS perfusion and increased serum FFA levels are indicative of vulnerable carotid plaques, which may be useful for the prediction of stroke in patients with carotid artery disease. PMID: 32039838 [PubMed - as supplied by publisher]
Source: Clinical Hemorheology and Microcirculation - Category: Hematology Authors: Tags: Clin Hemorheol Microcirc Source Type: research
ConclusionOur everyday clinical practice experience suggests 9.8  % of consecutive AIS patients present in the 4.5–9 h window and 2.2 % adhere to EXTEND neuroimaging eligibility criteria for IVT. Only 1.3% of AIS is eligible for IVT according to EXTEND neuroimaging and clinical eligibility criteria.
Source: Neuroradiology - Category: Radiology Source Type: research
ConclusionAdding CTP and/or a delayed-phase CTA to NCCT with arterial-phase CTA improves the decision-maker ’s confidence level and creates a trend towards a lower threshold for mechanical thrombectomy.
Source: Neuroradiology - Category: Radiology Source Type: research
We present the case of a 70-year-old man with multiple acute/subacute bilateral infarcts. The patient was found to have stenosis of the left internal carotid artery secondary to herpes zoster ophthalmicus vasculopathy, with involvement of the left proximal middle and anterior cerebral arteries. Angiographic studies also revealed A1 segment aplasia of the right anterior cerebral artery (ACA), thus indicating dependence on the left-sided circulation for perfusion of the bilateral ACA vascular territory.
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Tags: Case Report Source Type: research
Written by Meyers, edits by SmithA 50-ish year old man was working construction when he suddenly collapsed. Coworkers started CPR within 1 minute of collapse. EMS arrived within 10 minutes and continued CPR and ACLS, noting alternating asystole and sinus bradycardia during rhythm checks. He received various ACLS medications and arrived at the ED with a perfusing rhythm.Initial vitals included heart rate around 100 bpm and BP 174/96. Here is his initial ECG, very soon after ROSC:What do you think?Sinus tachycardia.  There is incomplete RBBB (QRS duration less than 120 ms).  There is diffuse STD, maximal in V4-V5 a...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Conclusion: This case exemplifies the potential of tenecteplase in achieving swift reperfusion in patients with large vessel occlusion associated with a substantial mismatch penumbral pattern.
Source: The Neurologist - Category: Neurology Tags: Case Report/Case Series Source Type: research
AbstractPurposeComputed tomography (CT) perfusion (CTP) source images contain both brain perfusion and cerebrovascular information, and may allow a dynamic assessment of collaterals. The purpose of the study was to compare the image quality and the collaterals identified on multiphase CT angiography (CTA) derived from CTP datasets (hereafter called CTPA) reconstructed with iterative model reconstruction (IMR) algorithm in patients with middle cerebral artery (MCA) steno-occlusion with those of routine CTA.MethodsConsecutive patients with a unilateral MCA steno-occlusion underwent non-contrast CT (NCCT), CTP, and CTA. CTPA ...
Source: Neuroradiology - Category: Radiology Source Type: research
Background: Collateral circulation in ischemic stroke patients plays an important role in infarct evolution und assessing patients' eligibility for endovascular treatment. By means of dynamic susceptibility contrast MRI, we aimed to investigate the effects of reperfusion, recanalization, and collateral flow on clinical and imaging outcomes after stroke.Methods: Retrospective analysis of 184 patients enrolled into the prospective observational 1000Plus study (clinicaltrials.org NCT00715533). Inclusion criteria were vessel occlusion on baseline MR-angiography, imaging within 24 h after stroke onset and follow-up perfusion im...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Imaging protocols for acute ischemic stroke varies significantly from center to center leading to challenges in research translation. We aimed to assess the inter-rater reliability of collateral grading systems derived from dynamic computed tomography angiography (CTA) and an optimized multiphase CTA and, to analyze the association of the two CTA modalities with CT perfusion (CTP) compartments by comparing the accuracy of dynamic CTA (dCTA) and optimized multiphase CTA (omCTA) in identifying CT perfusion (CTP) target mismatch patients. Acute ischemic stroke patients with a proximal large vessel occlusion who underwent whol...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
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