Wert des CBV-ASPECTS im Vergleich zum CTA-ASPECTS bei Patienten mit akutem ischämischem Schlaganfall

Added value of CT perfusion compared to CT angiography in predicting clinical outcomes of stroke patients treated with mechanical thrombectomy

by Ioannis Tsogkas
Doctoral thesis
Date of Examination:2020-12-03
Date of issue:2020-11-27
Advisor:Prof. Dr. Marios-Nikos Psychogios
Referee:Prof. Dr. Marios-Nikos Psychogios
Referee:Prof. Dr. Thorsten Roland Döppner
Persistent Address: http://dx.doi.org/10.53846/goediss-8333

 

 

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Abstract

English

Objectives CTP images analyzed with the Alberta stroke program early CT scale (ASPECTS) have been shown to be optimal predictors of clinical outcome. In this study we compared two biomarkers, the cerebral blood volume (CBV)- ASPECTS and the CTA-ASPECTS as predictors of clinical outcome after thrombectomy. Methods Stroke patients with thrombosis of the M1 segment of the middle cerebral artery were included in our study. All patients underwent initial multimodal CT with CTP and CTA on a modern CT scanner. Treatment consisted of full dose intravenous tissue plasminogen activator, when applicable, and mechanical thrombectomy. Three neuroradiologists separately scored CTP and CTA images with the ASPECTS score. Results Sixty-five patients were included. Median baseline CBV-ASPECTS and CTA-ASPECTS for patients with favourable clinical outcome at follow-up were 8 [interquartile range (IQR) 8-9 and 7-9 respectively]. Patients with poor clinical outcome showed a median baseline CBV-ASPECTS of 6 (IQR 5-8, P< 0.0001) and a median baseline CTA-ASPECTS of 7 (IQR 7-8, P = 0.18). Using CBV-ASPECTS and CTAASPECTS raters predicted futile reperfusions in 96 % and 56 % of the cases, respectively. Conclusions CBV-ASPECTS is a significant predictor of clinical outcome in patients with acute ischemic stroke treated with mechanical thrombectomy.
Keywords: Neuroimaging; Stroke; Thrombectomy; Patient selection
 
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