Abstract TP13: CT Perfusion-Guided Patient Selection for Acute Stroke Intervention Reduces In-Hospital Mortality

Abstract

Background and Purpose: Perfusion studies are increasingly used to triage acute stroke patients for endovascular recanalization therapies. However, the potential benefit of such an approach remains unproven. We compared the safety and efficacy of computed-tomography-perfusion-(CTP)-guided to time-guided mechanical recanalization in acute ischemic stroke (AIS) patients. Methods: A comparative analysis was conducted on 132 patients, 94 undergoing CTP-guided and 38 undergoing time-guided (maximum 8 hours from symptom onset) mechanical recanalization at our institution. The rates of recanalization, intracranial hemorrhage (ICH), in-hospital mortality, and overall clinical outcomes were compared. A multivariable logistic regression analysis was carried out to determine predictors of in-hospital mortality. Results: The two groups were comparable with respect to baseline characteristics with the exception of longer mean time interval from stroke onset to endovascular intervention in the CTP group (7.2 vs. 4.3 hours, p=0.006). The rate of partial-to-complete recanalization did not differ between the CTP and the non-CTP group (78.7% vs. 81.6%, respectively, p=0.71). Symptomatic and overall ICH occurred respectively in 8.5% and 18.1% in the CTP group versus 15.8% and 31.6% in the non-CTP group (p=0.06). The overall in-hospital mortality rate was significantly lower in the CTP group (15.9% vs. 36.8%, p=0.040). Likewise, mean modified Rankin Scale at discharge was 3.8 in the CTP group versus 4.4 in the non-CTP group (p=0.042). In multivariable analysis, CTP-based patient selection was an independent negative predictor of in-hospital mortality (OR= 3.2; 95% CI, 1.2-8.2; p=0.01). Conclusions: CTP-based patient selection was associated with lower ICH and mortality rates, with better overall patient outcomes. Our results suggest a significant benefit with CTP-guided patient selection and support the implementation of CTP-based protocols for triage of AIS patients for recanalization therapies.