Computed tomography perfusion as a method for selection of potential candidates for intravenous thrombolysis in acute ischemic stroke – presentation of clinical cases

Authors

  • Eray Halil UMHAT "St.Georgi"; Medical university – Plovdiv
  • B. Atanassova UMHAT "St.Georgi"; Medical university – Plovdiv
  • M. Hristova UMHAT "St.Georgi"; Medical university – Plovdiv
  • K. Chompalov UMHAT "St.Georgi"; Medical university – Plovdiv
  • N. Traikova UMHAT "St.Georgi"
  • N. Atanassova UMHAT "St.Georgi"
  • E. Dzhambazova Medical university – Plovdiv
  • P. Atanassova UMHAT "St.Georgi"

Keywords:

CT-perfusion, intravenous thrombolysis, ischemic stroke, neuroimaging

Abstract

Computed tomography perfusion (CTP) is an accesible and informative neuroimaging technique, which allows to expand the range of patients with acute ischemic stroke, who are eligible for intravenous thrombolysis (IVT). Rapid and precise identifiaction of the penumbra is of key significance for further therapeutic approach.
We present three clinical cases, illustrating various aspects of everyday clinical practice, in which performing intravenous thrombolysis without perfusion imaging of brain parenchyma would not be possible.

References

Albers, G.W., Lansberg, M.G., Kemp, S., Tsai, J.P., Lavori, P., Christensen, S., et al. A multicenter randomized controlled trial of endovascular therapy following imaging evaluation for ischemic stroke (DEFUSE 3). International Journal of Stroke. 2017, Mar., 24, 12, 8, 896-905.

Davis, S.M., Donnan, G.A., Parsons, M.W., et al. Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo-controlled randomised trial. Lancet Neurol 2008, 7, 299-309.

de Lucas, E.M., Sánchez, E., Gutiérrez, A., Mandly, A.G., Ruiz, E., Flórez, A.F., et al. CT Protocol for Acute Stroke: Tips and Tricks for General Radiologists. RadioGraphics. 2008, Oct., 28, 6, 1673-1687.

Lee. J-M, Grabb, M.C., Zipfel, G.J., Choi, D.W. Brain tissue responses to ischemia. Journal of Clinical Investigation. 2000, Sep., 15, 106, 6, 723-731.

Lui, Y.W., Tang, E.R., Allmendinger, A.M., Spektor, V.. Evaluation of CT Perfusion in the Setting of Cerebral Ischemia: Patterns and Pitfalls. American Journal of Neuroradiology. 2010, Feb., 25, 31, 9, 1552-1563.

Ma, H., Parsons, M.W., Christensen, S., et al. A multicentre, randomized, doubleblinded, placebo-controlled Phase III study to investigate EXtending the time for Thrombolysis in Emergency Neurological Deficits (EXTEND). Int J Stroke 2012, 7, 74-80.

Nael, K., Tadayon, E., Wheelwright, D., Metry, A., Fifi, J.T., Tuhrim, S., et al. Defining Ischemic Core in Acute Ischemic Stroke Using CT Perfusion: A Multiparametric Bayesian-Based Model. American Journal of Neuroradiology. 2019, Sep., 40, 9, 1491-1497.

Nogueira, R.G., Jadhav, A.P., Haussen, D.C., Bonafe, A., Budzik, R.F., Bhuva, P., et al. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. New England Journal of Medicine. 2018, Jan., 4, 378, 1, 11–21.

Paciaroni, M., Caso, V., Agnelli, G. The concept of ischemic penumbra in acute stroke and therapeutic opportunities. European Neurology. 2009, 61, 6, 321-330.

Srinivasan, A., Goyal, M., Azri, F.A., Lum. C,. State-of-the-Art Imaging of Acute Stroke. RadioGraphics. 2006, Oct., 26, S75-95.

Published

30.04.2023

How to Cite

Halil, E., Atanassova, B., Hristova, M., Chompalov, K., Traikova, N., Atanassova, N., Dzhambazova, E., & Atanassova, P. (2023). Computed tomography perfusion as a method for selection of potential candidates for intravenous thrombolysis in acute ischemic stroke – presentation of clinical cases. Bulgarian Neurology, 24(1), 36–39. Retrieved from https://www.nevrologiabg.com/journal/index.php/neurology/article/view/128

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