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Is CT perfusion helpful in the treatment allocation of patients with acute ischemic stroke? An expert-opinion analysis

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Abstract

Background

Intravenous tPA is the standard treatment for acute ischemic stroke within 4.5 hours of symptom onset. Neuroradiological selection is currently based upon non-contrast- brain CT scan (NCCT).

Aims

To verify, in an “expert-opinion setting”, the possible usefulness of CT perfusion (CTP) in decision-making toward i.v. thrombolysis.

Patients and method

One hundred and three consecutive patients with acute ischemic stroke who underwent NCCT and CTP were re-evaluated by an expert in cerebrovascular disease, to verify if adding CTP information would have changed expert’s opinion.

Results

After CTP, a definitive decision was made for 20 more patients, changing the proportion of patients candidate to i.v. tPA from 44% to 51%, and reducing uncertainty from 29% to 10%. CTP results were useful inmilder stroke (p = 0.01).

Conclusions

In a “real world” setting, CT perfusion could be useful for clinical decision, in particular for milder stroke.

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Author information

Authors and Affiliations

  1. Neurology Unit.E.O. Ospedali Galliera, Via Mura delle Cappuccine 14, 16128, Genoa, Italy

    Laura Strada, Daria Bianchini & Massimo Del Sette

  2. Neurology Department, Rabin Medical Center, Petach Tikva and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Jonathan Y. Streifler

  3. Radiology Unit, University of Novara, Novara, Italy

    Bruno Del Sette

  4. Clinical Trial Unit, Office of Scientific Director, E.O. Ospedali Galliera, Genoa, Italy

    Matteo Puntoni

  5. Neuroradiology Unit, E.O. Ospedali Galliera, Genoa, Italy

    Antonio Castaldi

Authors
  1. Laura Strada
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  2. Jonathan Y. Streifler
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  3. Bruno Del Sette
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  4. Matteo Puntoni
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  5. Antonio Castaldi
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  6. Daria Bianchini
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  7. Massimo Del Sette
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Corresponding author

Correspondence to Laura Strada.

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All clinical and neuroradiological data are stored in the local database.

Conflict of interest

The authors declare that they have no conflict of interest.

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Strada, L., Streifler, J.Y., Del Sette, B. et al. Is CT perfusion helpful in the treatment allocation of patients with acute ischemic stroke? An expert-opinion analysis. Neurol Sci 38, 1771–1777 (2017). https://doi.org/10.1007/s10072-017-3051-1

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  • DOI: https://doi.org/10.1007/s10072-017-3051-1

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