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stroke and CT perfusion

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https://www.readbyqxmd.com/read/28722696/hematocrit-and-serum-hemoglobin-do-not-influence-values-in-computed-tomography-perfusion-of-patients-with-acute-ischemic-stroke
#1
Grzegorz Marek Karwacki, Matthias Richard Benz, Anthony Joseph Tyndall, Stephan Ulmer
OBJECTIVE: There is a correlation between both serum hemoglobin (HGB) and hematocrit (HCT) and attenuation values of vessels in noncontrast-enhanced computed tomography (NECT), which could influence calculated perfusion maps in CT perfusion. METHODS: We retrospectively included 45 patients, who presented with acute new neurological symptoms and underwent NECT and CT perfusion (128-row multi detector scanner, coverage: 6.9 cm craniocaudally; 80 kV; 200 mAs; temporal resolution: 2 seconds using 40 mL Ultravist 370 at a flow rate of 5 mL/s) on admission and a follow-up MRI within 1 week of admission...
July 2017: Journal of Computer Assisted Tomography
https://www.readbyqxmd.com/read/28716981/prediction-of-clinical-outcome-after-acute-ischemic-stroke-the-value-of-repeated-noncontrast-computed-tomography-computed-tomographic-angiography-and-computed-tomographic-perfusion
#2
Jan W Dankbaar, Alexander D Horsch, Andor F van den Hoven, L Jaap Kappelle, Irene C van der Schaaf, Tom van Seeters, Birgitta K Velthuis
BACKGROUND AND PURPOSE: Early prediction of outcome in acute ischemic stroke is important for clinical management. This study aimed to compare the relationship between early follow-up multimodality computed tomographic (CT) imaging and clinical outcome at 90 days in a large multicenter stroke study. METHODS: From the DUST study (Dutch Acute Stroke Study), patients were selected with (1) anterior circulation occlusion on CT angiography (CTA) and ischemic deficit on CT perfusion (CTP) on admission, and (2) day 3 follow-up noncontrast CT, CTP, and CTA...
July 17, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28707434/utility-of-digital-subtraction-angiography-based-collateral-evaluation-in-medically-treated-acute-symptomatic-basilar-artery-stenosis
#3
W-J Lee, K-H Jung, Y J Ryu, J-M Kim, S-T Lee, K Chu, M Kim, S K Lee, J-K Roh
BACKGROUND AND PURPOSE: Although a stroke from atherosclerosis in the basilar artery (BA) often presents with mild initial stroke severity, it has heterogeneous clinical courses. We investigated the efficacy of digital subtraction angiography (DSA)-based collateral perfusion evaluation in association with long-term outcomes of medically treated symptomatic basilar artery stenosis. METHODS: From a registry database of all consecutive patients with stroke, we included 98 medically treated patients (due to mild initial stroke severity) [National Institute of Health Stroke Scale (NIHSS) scores ≤ 4; symptomatic basilar artery stenosis, 70-99%] with available initial diagnostic DSA...
July 14, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/28705822/focal-low-and-global-high-permeability-predict-the-possibility-risk-and-location-of-hemorrhagic-transformation-following-intra-arterial-thrombolysis-therapy-in-acute-stroke
#4
Y Li, Y Xia, H Chen, N Liu, A Jackson, M Wintermark, Y Zhang, J Hu, B Wu, W Zhang, J Tu, Z Su, G Zhu
BACKGROUND AND PURPOSE: The contrast volume transfer coefficient (K(trans)), which reflects blood-brain barrier permeability, is influenced by circulation and measurement conditions. We hypothesized that focal low BBB permeability values can predict the spatial distribution of hemorrhagic transformation and global high BBB permeability values can predict the likelihood of hemorrhagic transformation. MATERIALS AND METHODS: We retrospectively enrolled 106 patients with hemispheric stroke who received intra-arterial thrombolytic treatment...
July 13, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28687640/early-imaging-prediction-of-malignant-cerebellar-edema-development-in-acute-ischemic-stroke
#5
Matthias P Fabritius, Kolja M Thierfelder, Felix G Meinel, Ahmed E Othman, Franziska Dorn, Bastian O Sabel, Pierre Scheffler, Birgit Ertl-Wagner, Wieland H Sommer, Wolfgang G Kunz
BACKGROUND AND PURPOSE: Malignant cerebellar edema (MCE) is a life-threatening complication of acute ischemic stroke that requires timely diagnosis and management. Aim of this study was to identify imaging predictors in initial multiparametric computed tomography (CT), including whole-brain CT perfusion (WB-CTP). METHODS: We consecutively selected all subjects with cerebellar ischemic WB-CTP deficits and follow-up-confirmed cerebellar infarction from an initial cohort of 2635 patients who had undergone multiparametric CT because of suspected stroke...
July 7, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28658126/antihypertensive-treatments-for-spontaneous-intracerebral-hemorrhage-in-patients-with-cerebrovascular-stenosis-a-randomized-clinical-trial-atichst
#6
RANDOMIZED CONTROLLED TRIAL
Zengpanpan Ye, Xiaolin Ai, Jun Zheng, Xin Hu, Sen Lin, Chao You, Hao Li
INTRODUCTION: Antihypertensive treatment is associated with clinical outcomes in patients with spontaneous intracerebral hemorrhage (sICH). ADAPT showed that intensive blood pressure lowering (<140 mm Hg) does not reduce peri-hematoma regional cerebral blood flow (rCBF) in patients with sICH. However, the stenosis of main cerebral arteries that has a high presence in patients with sICH is well-known related to the brain ischemia. The effect of intensive BP lowering for sICH in patients with cerebrovascular stenosis is still unknown...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28646445/update-on-neurocritical-care-of-stroke
#7
Jason Siegel, Michael A Pizzi, J Brent Peel, David Alejos, Nnenne Mbabuike, Benjamin L Brown, David Hodge, W David Freeman
PURPOSE OF REVIEW: This review will highlight the recent advancements in acute ischemic stroke diagnosis and treatment, with special attention to new features and recommendations of stroke care in the neurocritical care unit. RECENT FINDINGS: New studies suggest that pre-hospital treatment of stroke with mobile stroke units and telestroke technology may lead to earlier stroke therapy with intravenous tissue plasminogen activator (tPA), and recent studies show tPA can be given in previously contraindicated situations...
August 2017: Current Cardiology Reports
https://www.readbyqxmd.com/read/28645744/reversible-hemispheric-hypoperfusion-in-two-cases-of-smart-syndrome
#8
Karmen Wai, Anna Balabanski, Nicholas Chia, Timothy Kleinig
Stroke-like migraine attacks after radiation therapy (SMART) syndrome manifests as prolonged episodes of cortical dysfunction, years after cranial irradiation. We present two cases demonstrating reversible hemispheric hypoperfusion. Case 1 presented with left hemispheric symptoms following previous similar episodes. CT perfusion (CTP) demonstrated reversible hemispheric hypoperfusion; subsequent investigations were consistent with SMART syndrome. Case 2 presented following the third episode of a hemispheric syndrome with near-identical CTP abnormalities...
June 20, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28601258/computed-tomography-perfusion-abnormalities-in-bilateral-thalamic-infarction-due-to-artery-of-percheron-occlusion
#9
Adam MacLellan, Karl Boyle
OBJECTIVE: We aimed to report a novel case of hyperacute computed tomography (CT) perfusion imaging abnormalities in artery of Percheron infarction. METHODS: We described a case of a 74-year-old man who presented acutely to the emergency room with witnessed sudden onset altered level of consciousness. RESULTS: Although initial hyperacute CT brain imaging was reported as normal, subsequent magnetic resonance imaging revealed bilateral paramedian thalamic infarction...
June 7, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28600481/optimal-thresholds-for-ischemic-penumbra-predicted-by-computed-tomography-perfusion-in-patients-with-acute-ischemic-stroke-treated-with-mechanical-thrombectomy
#10
Katsuharu Kameda, Junji Uno, Ryosuke Otsuji, Nice Ren, Shintaro Nagaoka, Kazushi Maeda, Yoshiaki Ikai, Hidefuku Gi
BACKGROUND AND PURPOSE: Optimal thresholds for ischemic penumbra detected by CT perfusion (CTP) in patients with acute ischemic stroke (AIS) have not been elucidated. In this study we investigated optimal thresholds for salvageable ischemic penumbra and the risk of hemorrhagic transformation (HT). METHODS: A total of 156 consecutive patients with AIS treated with mechanical thrombectomy (MT) at our hospital were enrolled. Absolute (a) and relative (r) CTP parameters including cerebral blood flow (aCBF and rCBF), cerebral blood volume (aCBV and rCBV), and mean transit time (aMTT and rMTT) were evaluated for their value in detecting ischemic penumbra in each of seven arbitrary regions of interest defined by the major supplying blood vessel...
June 9, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28583459/a-retrospective-study-of-clinical-outcomes-after-endovascular-treatment-in-acute-ischemic-stroke-patients-with-complete-anterior-circulation-infarction-taci-in-the-absence-of-multimodal-ct
#11
Chenghua Xu, Anyang Tao, Peng Wang, Zhimin Wang, Yi Zhang, Xiaoxiao Tao, Huaping Xin, Xian Zheng, Jiangxian Ying
OBJECTIVE: To analyze the positive predictive value of large artery occlusion and clinical prognosis in acute ischemic stroke patients with total anterior circulation infarct (TACI) who underwent endovascular treatment in the absence of multimodal CT angiography (CTA)/ CT perfusion (CTP). METHODS: The inclusion criteria for the acute ischemic stroke patients to receive endovascular treatment were as the follows: the OCSP classification was TACI, Alberta Stroke Program Early Computed Tomography Score (ASPECTS) ≥ 6, National Institutes of Health stroke scale (NIHSS) score ≥8, and within 4...
June 2, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28569123/diffusion-weighted-imaging-or-computerized-tomography-perfusion-assessment-with-clinical-mismatch-in-the-triage-of-wake-up-and-late-presenting-strokes-undergoing-neurointervention-with-trevo-dawn-trial-methods
#12
Tudor G Jovin, Jeffrey L Saver, Marc Ribo, Vitor Pereira, Anthony Furlan, Alain Bonafe, Blaise Baxter, Rishi Gupta, Demetrius Lopes, Olav Jansen, Wade Smith, Daryl Gress, Steven Hetts, Roger J Lewis, Ryan Shields, Scott M Berry, Todd L Graves, Tim Malisch, Ansaar Rai, Kevin N Sheth, David S Liebeskind, Raul G Nogueira
Rationale Efficacy of mechanical thrombectomy for acute stroke due to large vessel occlusion initiated beyond 6 h of time last seen well has not been demonstrated in randomized trials. Aim To establish whether subjects considered to have substantial areas of salvageable brain based on age-adjusted clinical core mismatch who can undergo endovascular treatment within 6-24 h from time last seen (TLSW) well have better outcomes at three months compared to subjects treated with standard medical therapy alone...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28559833/acute-intravenous-calcium-antagonist-for-suspected-hemiplegic-migraine-a-case-story
#13
Charlotte Lützhøft Rath, Jun He, Mette Maria Nordling, Troels Wienecke
Stroke mimics, like attacks of hemiplegic migraine, are challenging in acute stroke evaluation. We present a 28-year-old woman with a suspected hemiplegic migraine attack with left-sided hemiparalysis. Brain CT with perfusion imaging 1 h 54 min after symptom onset revealed hypoperfusion in the right hemisphere. The patient was treated with intravenous recombinant tissue plasminogen activator (rtPA) with no effect. After a subsequent intravenous verapamil infusion, the patient gained full motor function within 10 min...
January 2017: Case Reports in Neurology
https://www.readbyqxmd.com/read/28530158/analyzing-circle-of-willis-blood-flow-in-ischemic-stroke-patients-through-3d-stroke-arterial-flow-estimation
#14
Aichi Chien, Fernando Viñuela
Background The objective of ischemic stroke (IS) treatment is to achieve revascularization in cerebral arteries to restore blood flow. However, there is no available method to extract arterial flow data from clinical CTA images. We developed 3D Stroke Arterial Flow Estimation (SAFE), which provides blood flow data throughout the Circle of Willis based on 3D CTA and allows comparison of arterial flow distribution in the brain. Methods We implemented a newly developed 3D vascular reconstruction algorithm for clinical stroke CTA images...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28524121/-the-use-of-high-flow-extracranial-intracranial-artery-bypass-in-pathology-of-the-cerebral-and-brachiocephalic-arteries-technical-features-and-surgical-outcomes
#15
A V Dubovoy, K S Ovsyannikov, V E Guzhin, A V Cherepanov, D M Galaktionov, A M Perfil'ev, A O Sosnov
BACKGROUND: Poor outcomes of surgical treatment for complex cerebral aneurysms due to the development of cerebral ischemia were the cause to use cerebral revascularization surgery for this pathology. OBJECTIVE: the study objective was to master a high-flow extracranial-intracranial (EC-IC) artery bypass technique and evaluate its application in surgical treatment of complex and giant cerebral aneurysms as well as complex lesions of the brachiocephalic arteries. MATERIAL AND METHODS: Fifty two patients underwent high-flow IC-EC bypass surgery; of these, 34 patients had complex cerebral aneurysms, and 18 patients had complex stenotic occlusive lesions of the brachiocephalic arteries...
2017: Zhurnal Voprosy Neĭrokhirurgii Imeni N. N. Burdenko
https://www.readbyqxmd.com/read/28520753/comparative-accuracy-of-ct-perfusion-in-diagnosing-acute-ischemic-stroke-a-systematic-review-of-27-trials
#16
Jiantong Shen, Xianglian Li, Youping Li, Bing Wu
OBJECTIVE: To systematically evaluate and compare the diagnostic accuracy of CT perfusion (CTP), non-enhanced computed tomography (NCCT) and computed tomography angiography (CTA) in detecting acute ischemic stroke. METHODS: We searched seven databases and screened the reference lists of the included studies. The risk of bias in the study quality was assessed using QUADASII. We produced paired forest plots in RevMan to show the variation of the sensitivity and specificity estimates together with their 95% CI...
2017: PloS One
https://www.readbyqxmd.com/read/28520657/ct-based-techniques-for-brain-perfusion
#17
Pradeep Krishnan, Amanda Murphy, Richard I Aviv
Recent rapid advances in endovascular treatment for acute ischemic stroke highlight the crucial role of neuroimaging especially multimodal computed tomography (CT) including CT perfusion in stroke triage and management decisions. With an increasing focus on changes in cerebral physiology along with time-based matrices in clinical decisions for acute ischemic stroke, CT perfusion provides a rapid and practical modality for assessment and identification of salvageable tissue at risk and infarct core and provides a better understanding of the changes in cerebral physiology...
June 2017: Topics in Magnetic Resonance Imaging: TMRI
https://www.readbyqxmd.com/read/28515270/evaluation-of-hyperacute-infarct-volume-using-aspects-and-brain-ct-perfusion-core-volume
#18
COMPARATIVE STUDY
Jelle Demeestere, Carlos Garcia-Esperon, Pablo Garcia-Bermejo, Fouke Ombelet, Patrick McElduff, Andrew Bivard, Mark Parsons, Christopher Levi
OBJECTIVE: To compare the accuracy of Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and CT perfusion to detect established infarction in acute anterior circulation stroke. METHODS: We performed an observational study in 59 acute anterior circulation ischemic stroke patients who underwent brain noncontrast CT, CT perfusion, and MRI within 100 minutes from CT imaging. ASPECTS scores were calculated by 4 blinded vascular neurologists. The accuracy of ASPECTS and CT perfusion core volume to detect an acute MRI diffusion lesion of ≥70 mL was evaluated using receiver operating characteristics analysis and optimum cutoff values were calculated using Youden J...
June 13, 2017: Neurology
https://www.readbyqxmd.com/read/28486789/computed-tomographic-perfusion-to-predict-response-to-recanalization-in-ischemic-stroke
#19
MULTICENTER STUDY
Maarten G Lansberg, Soren Christensen, Stephanie Kemp, Michael Mlynash, Nishant Mishra, Christian Federau, Jenny P Tsai, Sun Kim, Raul G Nogueria, Tudor Jovin, Thomas G Devlin, Naveed Akhtar, Dileep R Yavagal, Diogo Haussen, Seena Dehkharghani, Roland Bammer, Matus Straka, Greg Zaharchuk, Michael P Marks, Gregory W Albers
OBJECTIVE: To assess the utility of computed tomographic (CT) perfusion for selection of patients for endovascular therapy up to 18 hours after symptom onset. METHODS: We conducted a multicenter cohort study of consecutive acute stroke patients scheduled to undergo endovascular therapy within 90 minutes after a baseline CT perfusion. Patients were classified as "target mismatch" if they had a small ischemic core and a large penumbra on their baseline CT perfusion...
June 2017: Annals of Neurology
https://www.readbyqxmd.com/read/28465268/intracranial-blood-flow-changes-in-patients-with-high-grade-severe-carotid-artery-stenosis-after-stenting
#20
Lei Huang, Wenjie Cao, Liang Ge, Gang Lu, Xiaolong Zhang, Daoying Geng
OBJECTIVE: We investigated whether the cerebral hemodynamic changes of pre- and poststenting in patients with severe carotid stenosis differ by stenosis grades. MATERIALS AND METHODS: We prospectively recruited patients who underwent carotid artery stenting (CAS) after acute ischemic stroke from June 2014 to December 2015. We compared the mean relative cerebral blood flow changes (rCBF) (measured by whole-brain computed tomography [CT] perfusion) pre- and poststenting in patients with high-grade severe stenosis (HGSS 90%-99%) versus patients with low-grade severe stenosis (LGSS 70%-89%)...
April 29, 2017: World Neurosurgery
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