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Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Research Article

Application of Computed Tomography Perfusion Imaging-guided Mechanical Thrombectomy in Ischemic Stroke Patients with Large Vessel Occlusion beyond the Therapeutic Time Window

Author(s): Shifeng Xiang, Ya Su, Shuyuan Li, Sujun Yang and Yiping Wu*

Volume 20, 2024

Published on: 20 July, 2023

Article ID: e080623217777 Pages: 7

DOI: 10.2174/1573405620666230608091800

open_access

Abstract

Introduction: To explore the feasibility of applying computed tomography perfusion (CTP) imaging-guided mechanical thrombectomy in acute ischemic stroke patients with large vessel occlusion beyond the therapeutic time window.

Methods: The clinical data of acute cerebral infarction patients with large vessel occlusion who were beyond the therapeutic time window and admitted to Handan Central Hospital from January 2021 to March 2022 were retrospectively analyzed. All patients were assessed by the National Institutes of Health Stroke Scale (NIHSS) and were examined by one-stop CTP imaging. The preoperative onset time of the disease was more than 6 h. Fourteen patients underwent magnetic resonance imaging examination at the same time. Fifty-four patients were retrospectively divided into two groups based on the treatment methods: the mechanical thrombectomy group had 21 patients and the conservative treatment group had 33 patients. NIHSS scoring and computed tomography scan were performed before treatment, 6 h, 24 h, 7 days, and 30 days after treatment.

Results: The NIHSS scores of the patients with acute cerebral large vessel occlusion who underwent CTP imaging-guided mechanical thrombectomy at 6 h, 24 h, 7 days, and 30 days after treatment were compared with those of the conventional treatment group. The NIHSS score of the mechanical thrombectomy group was significantly better, and the difference was statistically significant (P < 0.05). In terms of the prognosis rate and expansion rate of infarct core volume, the patients of the mechanical thrombectomy group had a better prognosis, and the difference was statistically significant (P < 0.05). Artificial intelligence-assisted CTP diagnosis can facilitate the automatic evaluation of diseases and enable quick judgments that are independent of radiologists’ evaluation, but it may pose a problem in the determination of infarct core volume (either being too high or too low).

Conclusion: It is of great significance to apply CTP imaging in guiding the mechanical thrombectomy procedure in acute stroke patients with large vessel occlusion who are beyond the therapeutic time window.

Keywords: Mechanical thrombectomy, Beyond therapeutic time window, Computed tomography, X-ray, Perfusion imaging, Stroke patients.

[1]
Lassalle L, Turc G, Tisserand M, et al. Aspects (alberta stroke program early CT score) assessment of the perfusion-diffusion mismatch. Stroke 2016; 47(10): 2553-8.
[http://dx.doi.org/10.1161/STROKEAHA.116.013676] [PMID: 27625381]
[2]
Schröder J, Thomalla G. A critical review of alberta stroke program early CT score for evaluation of acute stroke imaging. Front Neurol 2017; 7(7): 245.
[http://dx.doi.org/10.3389/fneur.2016.00245] [PMID: 28127292]
[3]
Raza SA, Barreira CM, Rodrigues GM, et al. Prognostic importance of CT aspects and CT perfusion measures of infarction in anterior emergent large vessel occlusions. J Neurointerv Surg 2019; 11(7): 670-4.
[http://dx.doi.org/10.1136/neurintsurg-2018-014461]
[4]
Liu X, Sun W, Zhu W, et al. Guidelines for early endovascular interventional diagnosis and treatment of acute ischemic stroke in China 2018. Chin J Neurol 2018; 51(9): 683-91.
[5]
Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association /American Stroke Association. Stroke 2018; 49(3): e46-e110.
[http://dx.doi.org/10.1161/STR.0000000000000158] [PMID: 29367334]
[6]
Saver JL, Goyal M, Bonafe A, et al. Solitaire™ with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) trial: Protocol for a randomized, controlled, multicenter study comparing the Solitaire revascularization device with IV tPA with IV tPA alone in acute ischemic stroke. Int J Stroke 2015; 10(3): 439-48.
[http://dx.doi.org/10.1111/ijs.12459] [PMID: 25777831]
[7]
Gunda B, Sipos I, Stang R, et al. Comparing extended versus standard time window for thrombectomy: Caseload, patient characteristics, treatment rates and outcomes—a prospective single-centre study. Neuroradiology 2021; 63(4): 603-7.
[http://dx.doi.org/10.1007/s00234-020-02531-8] [PMID: 32935174]
[8]
Li J, Zhang J, Xiong J, et al. Evaluation of cerebral hemodynamics in patients with ischemic cerebrovascular disease by CT perfusion imaging. Chin J Brain Dis Rehab 2015; 5(4): 235-8.
[9]
Geng Y, Guo G, Liu L. Prediction of hemorrhagic transformation in patients with ischemic stroke based on perfusion CT microvascular permeability. Chin J Geriatr Heart, Brain Vessel Dis 2015; 17(12): 1286-8.
[10]
Yang C, Zhang L, Zhang H, et al. Application value of 320-slice CT perfusion imaging of the whole brain in evaluating ischemic cerebrovascular disease. Chin J Crit Care Med 2015; 35(12): 198-9.
[11]
Wang Y. Feasibility and value of 128-slice spiral CT perfusion scan of the whole brain and low-dose half-time scan. Chin J CT & MRI 2018; 16(9): 87-9.
[12]
Li W, Shang W. Analysis of the application value of susceptibility-weighted imaging technology in ischemic cerebrovascular disease. Chin J CT & MRI 2017; 15(11): 35-7.
[13]
Zhang J, Wang Y, Zhang J. The early CT score of the alberta stroke project on diffusion-weighted imaging in evaluating the prognosis of acute anterior circulation cerebral infarction by intravenous thrombolysis. Chin J Cardiovas Dis 2018; 20(1): 60-3.
[14]
Wang M, Zhou J, Wu A. Research progress of intravenous thrombolysis and endovascular treatment of acute ischemic stroke. Chin J Neurol 2017; 50(5): 391-5.
[15]
Yang Z. The application of CTP-ASPECTS score in the prognosis judgment of patients with anterior circulation infarction in acute stage. Guangdong Yixue 2012; 33(9): 1249-51.
[16]
Liebeskind DS, Jahan R, Nogueira RG, Jovin TG, Lutsep HL, Saver JL. Serial Alberta Stroke Program early CT score from baseline to 24 hours in Solitaire Flow Restoration with the Intention for Thrombectomy study: A novel surrogate end point for revascularization in acute stroke. Stroke 2014; 45(3): 723-7.
[http://dx.doi.org/10.1161/STROKEAHA.113.003914] [PMID: 24525954]
[17]
Berkhemer OA, Fransen PSS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372(1): 11-20.
[http://dx.doi.org/10.1056/NEJMoa1411587] [PMID: 25517348]
[18]
Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372(24): 2285-95.
[http://dx.doi.org/10.1056/NEJMoa1415061] [PMID: 25882376]
[19]
Motyer R, Kok HK, Asadi H, et al. Outcomes of endovascular treatment for acute large-vessel ischaemic stroke more than 6 h after symptom onset. J Intern Med 2017; 282(6): 537-45.
[http://dx.doi.org/10.1111/joim.12680] [PMID: 28875550]
[20]
Maslias E, Nannoni S, Ricciardi F, et al. Procedural complications during early versus late endovascular treatment in acute stroke: Frequency and clinical impact. Stroke 2021; 52(3): 1079-82.
[http://dx.doi.org/10.1161/STROKEAHA.120.031349] [PMID: 33467881]
[21]
Tsivgoulis G, Katsanos AH, Schellinger PD, et al. Advanced neuroimaging in stroke patient selection for mechanical thrombectomy. Stroke 2018; 49(12): 3067-70.
[http://dx.doi.org/10.1161/STROKEAHA.118.022540] [PMID: 30571421]

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