Independent Significance of Visual Assessment of Perfusion CT Maps in Anterior Circulation Stroke Patients Treated with Mechanical Thrombectomy.

Abstract

In the absence of an automated software analysis, the role of computed tomography perfusion (CTP) in a real time clinical practice is not well established. We evaluated the clinical significance of a widely accessible and simple visual grading scale of CTP in the anterior circulation of acute ischemic stroke (AIS) patients treated with mechanical thrombectomy (MT). The single center consecutive CT investigations of AIS patients treated with MT in the anterior circulation have been evaluated retrospectively. ASPECT score and collateral circulation evaluation based on the Maas score were determined. Time to peak parametric maps, derived from CTP, were graded into four categories, from least to most favorable. The primary endpoint was functional outcome evaluated as modified Rankin Scale (mRS) ≤ 2 at 90days after MT. We included 318 patients in the analysis; 142 (45%) patients had mRS ≤ 2 after 90days, mortality rate was 24%. Higher CTP and Maas score were significantly correlated with better clinical outcome (Pearson χ2 25.0 and 37.7, respectively; p < 0.01). Collateral circulation and CTP grades were strongly interrelated (Pearson χ2 78.6; p < 0.01). The CTP grade demonstrated statistically significant independent correlation with the clinical outcome irrespective of the collateral circulation grade, ASPECT score and age (OR 2.5; p = 0.011). The correlation was more pronounced in patients with normal collateral circulation (OR 3.27; p = 0.029). We demonstrated that both visually graded CTP and collateral circulation grade strongly correlated with the clinical outcome of MT in the anterior circulation of AIS patients. Importantly, CTP correlated with the clinical outcome independent of the collateral circulation.