April 11, 2018

Journal of NeuroInterventional Surgery

Can diffusion- and perfusion-weighted imaging alone accurately triage anterior circulation acute ischemic stroke patients to endovascular therapy?

Acute ischemic stroke (ais) patients who benefit from endovascular treatment have a large vessel occlusion (lVO), small core infarction, and salvageable brain. We determined if diffusion-weighted imaging (DWi) and perfusion-weighted imaging (PWi) alone can correctly identify and localize anterior circulation lVO and accurately triage patients to endovascular thrombectomy (eT)....

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February 22, 2018

New England Journal of Medicine

Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging

Endovascular thrombectomy for ischemic stroke 6 to 16 hours after a patient was last known to be well plus standard medical therapy resulted in better functional outcomes than standard medical therapy alone among patients with proximal middle-cerebral-artery or internal-carotid-artery occlusion and a region of tissue that was ischemic but not yet infarcted...

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January 24, 2018

Stroke

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

The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations for clinicians caring for adult patients with acute arterial ischemic stroke in a single document. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 guidelines and subsequent updates...

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January 4, 2018

New England Journal of Medicine

Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct

The effect of endovascular thrombectomy that is performed more than 6 hours after the onset of ischemic stroke is uncertain. Patients with a clinical deficit that is disproportionately severe relative to the infarct volume may benefit from late thrombectomy....

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December 2017

Journal of NeuroInterventional Surgery

Referral facility CT perfusion prior to inter-facility transfer in patients undergoing mechanical thrombectomy

We conducted a single center retrospective review of a prospectively maintained database of consecutive ischemic stroke patients transferred to our center for consideration of endovascular therapy...

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August 2017

Journal of Cerebral Blood Flow & Metabolism

Relative cerebral blood volume is associated with collateral status and infarct growth in stroke patients in SWIFT PRIME

We aimed to evaluate how predefined candidate cerebral perfusion parameters correlate with collateral circulation status and to assess their capacity to predict infarct growth in patients with acute ischemic stroke (AIS) eligible for endovascular therapy...

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August 2017

European Journal of Radiology

Brain ischemia: CT and MRI techniques in acute ischemic stroke

Computed tomography (CT) / CT angiography or magnetic resonance (MR) / MR angiography imaging are used to exclude stroke mimics and haemorrhage, to determine the cause and mechanism of stroke, to define the extension of brain infarct and to identify the arterial occlusion...

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March 2017

ANNALS of Neurology

Computed Tomographic Perfusion to Predict Response to Recanalization in Ischemic Stroke

Patients with middle cerebral artery and distal carotid occlusions were randomized to treatment with tPA (tissue-type plasminogen activator) alone or tPA+stentriever thrombectomy. The primary outcome was the distribution of the...

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May 2, 2017

Stroke

Efficacy of Stent-Retriever Thrombectomy in Magnetic Resonance Imaging Versus Computed Tomographic Perfusion–Selected Patients in SWIFT PRIME Trial (Solitaire FR With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke)

Patients with middle cerebral artery and distal carotid occlusions were randomized to treatment with tPA (tissue-type plasminogen activator) alone or tPA+stentriever thrombectomy. The primary outcome was the distribution of the...

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March 24, 2017

International Journal of Stroke

A multicenter randomized controlled trial of endovascular therapy following imaging evaluation for ischemic stroke (DEFUSE 3)

Early reperfusion in patients experiencing acute ischemic stroke is effective in patients with large vessel occlusion. No randomized data are available regarding the safety and efficacy of endovascular therapy beyond 6h from symptom onset...

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February 13, 2017

Stroke

Computed Tomographic Perfusion Selection and Clinical Outcomes After Endovascular Therapy in Large Vessel Occlusion Stroke

Different imaging paradigms have been used to select patients for endovascular therapy in stroke. We sought to determine whether computed tomographic perfusion (CTP) selection improves endovascular therapy outcomes compared with...

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January 13, 2017

Stroke

Predictive Value of RAPID Assessed Perfusion Thresholds on Final Infarct Volume in SWIFT PRIME (Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment)

We aimed to analyze the accuracy of various rCBV and rCBF thresholds for predicting the 27-hour infarct volume using RAPID automated analysis software from the SWIFT PRIME trial...

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January 8, 2017

The Lancet Neurology

Changing the face of the stroke stopwatch

Treatment for stroke is determined by the stopwatch. Missing the few hours that are the window of opportunity between stroke onset and the time of diagnosis make many patients ineligible for reperfusion therapy, because of concerns that treatment might be too risky or ineffective...

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November 15, 2016

Stroke

Optimal Computed Tomographic Perfusion Scan Duration for Assessment of Acute Stroke Lesion Volumes

We retrospectively assessed the impact of gradual truncation of the scan duration on acute ischemic lesion volume measurements. For each scan, we identified its optimal scan time, defined as the shortest scan duration that yields measurements of the ischemic lesion volumes similar to those obtained with longer scanning, and...

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May 3, 2016

Stroke

Comparison of perfusion CT software to predict the final infarct volume after thrombectomy

Computed tomographic perfusion represents an interesting physiological imaging modality to select patients for reperfusion therapy in acute ischemic stroke. The purpose of our study was to determine the accuracy of different commercial perfusion CT software packages (Philips (A), Siemens (B), and RAPID (C)) to predict the final infarct volume (FIV) after mechanical thrombectomy..

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February 18, 2016

Medscape Medical News

CT Profile Flags Stroke Patients Who May Have More Time

Stroke patients identified with computed tomography (CT) perfusion as having a distinctive neurologic profile show potential benefits from endovascular interventions well beyond the conventional 6-hour window, new research suggests...

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October 17, 2015

ANNALS of Neurology

Ischemic core and hypoperfusion volumes predict infarct size in SWIFT PRIME.

Within the context of a prospective randomized trial (SWIFT PRIME), we assessed whether early imaging of stroke patients, primary with CT perfusion, can estimate the size of the irreversibly injured ischemic core and the volume of critically hypoperfused tissue. We also evaluated the accuracy of ischemic core and hypoperfusion volumes for predicting infarct volume in patients with the target mismatch profile...

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May 6, 2015

Journal of Cerebral Blood Flow & Metabolism

A benchmarking tool to evaluate computer tomography perfusion infarct core predictions against a DWI standard

Differences in research methodology have hampered the optimization of Computer Tomography Perfusion (CTP) for identification of the ischemic core. We aim to optimize CTP core identification using a novel benchmarking tool. The benchmarking tool consists of an imaging library and a statistical analysis algorithm to evaluate the performance of CTP...

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Jan. 1, 2015

New England Journal of Medicine

Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection

Trials of endovascular therapy for ischemic stroke have produced variable results. We conducted this study to test whether more advanced imaging selection, recently developed devices, and earlier intervention improve outcomes...

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July 7, 2015

Stroke

Relationships Between Imaging Assessments and Outcomes in Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke

Imaging findings can predict outcomes in patients with acute stroke. Relationships between imaging findings and clinical and imaging outcomes in patients randomized to intravenous tissue-type plasminogen activator–alone versus tissue-type plasminogen activator plus endovascular therapy (Solitaire device) in the Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) study were assessed...

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April 17, 2015

New England Journal of Medicine

Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke

Among patients with acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, less than 40% regain functional independence when treated with intravenous tissue plasminogen activator (t-PA) alone. Thrombectomy with the use of a stent retriever, in addition to intravenous t-PA, increases reperfusion rates and may improve long-term functional outcome...

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November, 2010

Journal of Magnetic Resonance Imaging

Real-time diffusion-perfusion mismatch analysis in acute stroke

Diffusion-perfusion mismatch can be used to identify acute stroke patients that could benefit from reperfusion therapies. Early assessment of the mismatch facilitates necessary diagnosis and treatment decisions in acute stroke. We developed the RAPID processing of PerfusIon and Diffusion (RAPID) for unsupervised, fully automated processing of perfusion and diffusion data for the purpose of expedited routine clinical assessment...

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May 3, 2016

Wolters Kluwer

MR and CT Perfusion and Pharmacokinetic Imaging: Clinical Applications and Theoretical Principles

International experts in the field demonstrate how perfusion and pharmacokinetic imaging can be effectively used to analyze medical conditions, helping you reach accurate diagnoses and monitor disease progression and response to therapy...

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September 3, 2012

Lancet Neurology

MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort study

Whether endovascular stroke treatment improves clinical outcomes is unclear because of the paucity of data from randomised placebo-controlled trials. We aimed to establish whether MRI can be used to identify patients who are most likely to benefit from endovascular reperfusion...

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November 28, 2012

Stroke

Early Diffusion-Weighted Imaging and Perfusion-Weighted Imaging Lesion Volumes Forecast Final Infarct Size in DEFUSE 2

It is hypothesized that early diffusion-weighted imaging (DWI) lesions accurately estimate the size of the irreversibly injured core and thresholded perfusion-weighted imaging (PWI) lesions (time to maximum of tissue residue function [Tmax] >6 seconds) approximate the volume of critically hypoperfused tissue. With incomplete reperfusion, the union of baseline DWI and posttreatment PWI is hypothesized to predict infarct volume....

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