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2017 ; 140
(3
): 684-691
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Perfusion computed tomography in patients with stroke thrombolysis
#MMPMID28040669
Kawano H
; Bivard A
; Lin L
; Ma H
; Cheng X
; Aviv R
; O'Brien B
; Butcher K
; Lou M
; Zhang J
; Jannes J
; Dong Q
; Levi CR
; Parsons MW
Brain
2017[Mar]; 140
(3
): 684-691
PMID28040669
show ga
See Saver (doi:10.1093/awx020) for a scientific commentary on this article.Stroke
shortens an individual's disability-free life. We aimed to assess the relative
prognostic influence of pre- and post-treatment perfusion computed tomography
imaging variables (e.g. ischaemic core and penumbral volumes) compared to
standard clinical predictors (such as onset-to-treatment time) on long-term
stroke disability in patients undergoing thrombolysis. We used data from a
prospectively collected international, multicentre, observational registry of
acute ischaemic stroke patients who had perfusion computed tomography and
computed tomography angiography before treatment with intravenous alteplase.
Baseline perfusion computed tomography and follow-up magnetic resonance imaging
were analysed to derive the baseline penumbra volume, baseline ischaemic core
volume, and penumbra salvaged from infarction. The primary outcome measure was
the effect of imaging and clinical variables on Disability-Adjusted Life Year.
Clinical variables were age, sex, National Institutes of Health Stroke Scale
score, and onset-to-treatment time. Age, sex, country, and 3-month modified
Rankin Scale were extracted from the registry to calculate disability-adjusted
life-year due to stroke, such that 1 year of disability-adjusted life-year
equates to 1 year of healthy life lost due to stroke. There were 772 patients
receiving alteplase therapy. The number of disability-adjusted life-year days
lost per 1 ml of baseline ischaemic core volume was 17.5 (95% confidence
interval, 13.2-21.9 days, P < 0.001). For every millilitre of penumbra salvaged,
7.2 days of disability-adjusted life-year days were saved (? = -7.2, 95%
confidence interval, -10.4 to -4.1 days, P < 0.001). Each minute of earlier
onset-to-treatment time resulted in a saving of 4.4 disability-free days after
stroke (1.3-7.5 days, P = 0.006). However, after adjustment for imaging
variables, onset-to-treatment time was not significantly associated with savings
in disability-adjusted life-year days. Pretreatment perfusion computed tomography
can (independently of clinical variables) predict significant gains, or loss, of
disability-free life in patients undergoing reperfusion therapy for stroke. The
effect of earlier treatment on disability-free life appears explained by salvage
of penumbra, particularly when the ischaemic core is not too large.
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