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Research ArticleBrainF

Cerebral Blood Flow Thresholds for Tissue Infarction in Patients with Acute Ischemic Stroke Treated with Intra-Arterial Revascularization Therapy Depend on Timing of Reperfusion

K. Mui, A.J. Yoo, L. Verduzco, W.A. Copen, J.A. Hirsch, R.G. González and P.W. Schaefer
American Journal of Neuroradiology May 2011, 32 (5) 846-851; DOI: https://doi.org/10.3174/ajnr.A2415
K. Mui
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A.J. Yoo
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L. Verduzco
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W.A. Copen
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J.A. Hirsch
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R.G. González
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P.W. Schaefer
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Abstract

BACKGROUND AND PURPOSE: MR perfusion CBF values can distinguish hypoperfused penumbral tissue likely to infarct from that which is likely to recover. Our aim was to determine if CBF thresholds for tissue infarction depend on the timing of recanalization in patients with acute stroke treated with IAT.

MATERIALS AND METHODS: Twenty-six patients with acute proximal anterior circulation strokes underwent DWI and PWI before IAT. rCBF was obtained in the following areas: 1) C with abnormal DWI, reduced CBF, follow-up infarction; 2) PI with normal DWI, reduced CBF, follow-up infarction and 3) PNI with normal DWI, reduced CBF, normal follow-up. rCBF in tissue reperfused at <6 hours (early recanalizers), in tissue reperfused at >6 hours (late RC), and in NRC was compared.

RESULTS: For C, mean rCBF was 0.13 (SEM, 0.002), 0.29 (0.007), and 0.21 (0.004) for early recanalizers, late recanalizers, and nonrecanalizers, respectively (P < .001, for all comparisons). For PI, mean rCBF was 0.34 (0.006), 0.38 (0.008), and 0.39 (0.005) for early recanalizers, late recanalizers, and nonrecanalizers, respectively (P < .001 for early-versus-late recanalizers and versus nonrecanalizers; P > .05 for late recanalizers versus nonrecanalizers). For PNI, the mean rCBF was 0.38 (0.002), 0.48 (0.003), and 0.48 (0.004) for early recanalizers, late recanalizers, and nonrecanalizers, respectively (P < .001 for early-versus-late recanalizers and nonrecanalizers; P > .05 for late recanalizers versus nonrecanalizers). ROC analyzis demonstrated optimal rCBF thresholds for tissue infarction of 0.27 (sensitivity, 80%; specificity, 87%), 0.44 (sensitivity, 77%; specificity, 75%), and 0.41 (sensitivity, 78%; specificity, 77%) for early recanalizers, late recanalizers, and nonrecanalizers, respectively.

CONCLUSIONS: CBF thresholds for tissue infarction in patients with acute stroke are lower in tissue that is reperfused at earlier time points. This information may be important in selecting patients who might benefit from reperfusion therapy.

Abbreviations

AIS
acute ischemic stroke
AUC
area under the ROC curve
C
infarct core
CBF
cerebral blood flow
CBV
cerebral blood volume
DWI
diffusion-weighted imaging
FLAIR
fluid-attenuated inversion recovery
IAT
intra-arterial therapy
ICA
internal carotid artery
IV
intravenous
MCA
middle cerebral artery
MTT
mean transit time
OOP
optimal operating point
PI
penumbra that infarcts
PNI
penumbra that does not infarct
PWI
perfusion-weighted imaging
rCBF
relative cerebral blood flow
ROC
receiver operating characteristic analysis
SE
standard error
SEM
standard error of the mean
Tonset
time from stroke onset to vessel recanalization
tPA
tissue plasminogen activator
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American Journal of Neuroradiology: 32 (5)
American Journal of Neuroradiology
Vol. 32, Issue 5
1 May 2011
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K. Mui, A.J. Yoo, L. Verduzco, W.A. Copen, J.A. Hirsch, R.G. González, P.W. Schaefer
Cerebral Blood Flow Thresholds for Tissue Infarction in Patients with Acute Ischemic Stroke Treated with Intra-Arterial Revascularization Therapy Depend on Timing of Reperfusion
American Journal of Neuroradiology May 2011, 32 (5) 846-851; DOI: 10.3174/ajnr.A2415

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Cerebral Blood Flow Thresholds for Tissue Infarction in Patients with Acute Ischemic Stroke Treated with Intra-Arterial Revascularization Therapy Depend on Timing of Reperfusion
K. Mui, A.J. Yoo, L. Verduzco, W.A. Copen, J.A. Hirsch, R.G. González, P.W. Schaefer
American Journal of Neuroradiology May 2011, 32 (5) 846-851; DOI: 10.3174/ajnr.A2415
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