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Abstract Details

Computed Tomography Perfusion Imaging Profiles Are Similar Before and After Transfer to a Comprehensive Stroke Center
Cerebrovascular Disease and Interventional Neurology
P11 - Poster Session 11 (8:00 AM-9:00 AM)
13-003

To quantify changes in CT perfusion (CTP) imaging profiles in a cohort of stroke transfers.

CTP is an important tool for identifying candidates for mechanical thrombectomy (MT). CTP is increasingly available in regional facilities, but whether pre-transfer CTP may be relied upon for treatment decisions is unclear.  

Patients with confirmed ischemic stroke who received CTP before and after transfer to a comprehensive stroke center (CSC) were included. We compared perfusion mismatch (MM), core infarct volume (CIV), and favorability of imaging for MT candidacy (defined as the presence of LVO and MM/CIV ratio of >1.8). Regression models were used to examine predictors of CIV growth including hypoperfusion intensity ratio (HIR) and time between studies.

Over a 24-month period, 61 patients met inclusion criteria. Median age was 71 (IQR 60-80), 52% were female, median NIHSS was 14 (IQR 4-19), and most patients had occlusion of the internal carotid and/or middle cerebral arteries (77%). The median time from last known well (LKW) to initial CT was 148 minutes (IQR 71-620) and median time between imaging studies was 149 minutes (IQR 126-194). Median CIV growth was 0 mL (IQR 0-6) and 8% (5/61) had growth ≥25mL. In linear regression, higher HIR predicted CIV growth (β=24.3, p=0.04), but time from LKW to presentation and time between imaging studies did not. Imaging studies taken at the regional and CSC sites demonstrated excellent agreement in classifying patients as candidates for MT (kappa 0.778 [95% CI: 0.611-0.944]). A favorable regional CTP profile was 93% sensitive for MT delivery at the CSC with a positive predictive value of 63%.

CIV growth between facilities was minimal despite relatively long interfacility transport times and was predicted by the regional HIR. A favorable regional imaging profile demonstrated high agreement with imaging results at the CSC and was strongly associated with MT treatment.

Authors/Disclosures
Esam Abobaker, DO (Spectrum Health, Michigan State University)
PRESENTER 		Dr. Abobaker has nothing to disclose.
Malgorzata Miller, MD (Corewell Health) The institution of Dr. Miller has received research support from NIH StrokeNet VERIFY trial.
Brian Wideman, DO Dr. Wideman has nothing to disclose.
Nadeem I. Khan, MD (Spectrum Health) Dr. Khan has nothing to disclose.
Muhib Khan, MD, FAAN (Mayo Clinic) The institution of Dr. Khan has received research support from Mayo Clinic 好色先生 Grant . The institution of Dr. Khan has received research support from Mayo Clinic Small Grants .
Mathew J. Reeves, PhD, BVSc Mathew J. Reeves, PhD, BVSc has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association.
John Oostema, MD Dr. Oostema has received personal compensation for serving as an employee of Life EMS 好色先生 Centre. Dr. Oostema has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Various law firms.