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Perfusion computed tomography in patients with stroke thrombolysis

View Article: PubMed Central - PubMed

ABSTRACT

See Saver (doi:10.1093/awx020) for a scientific commentary on this article.

The extent to which CT perfusion imaging variables before and after reperfusion therapy for stroke predict the length of subsequent disability-free life is unclear. Kawano et al. show that saving a millilitre of penumbra translates into benefits equivalent to more than a week of disability-free life.

No MeSH data available.


Related in: MedlinePlus

Relationship between disability adjusted life-days, baseline penumbra volume (A), salvaged penumbra volume (B), onset-to-treatment time (C) and baseline NIHSS score (D) in all patients, patients with recanalization, and patients with poor recanalization. (A) Patients lost 4.1 DALY-days per 1 ml baseline penumbra (β = 4.1, 95% CI, 0.8–7.5 days, P = 0.015). In patients with recanalization, baseline penumbra volume did not affect the DALY-days lost due to stroke (β = 0.7, 95% CI, −4.8–13.5 days, P = 0.808). However, patients without recanalization lost 7.5 DALY-days per 1 ml of baseline penumbra (β = 7.5, 95% CI, 2.8–12.3, P = 0.002). (B) Each 1 ml of salvaged penumbra resulted in a saving of 7.2 DALY-days (β = −7.2, 95% CI, −10.4 to −4.1, P < 0.001). In patients with recanalization, each 1 ml of salvaged penumbra resulted in a saving of 11.8 DALY-days (β = −11.8, 95% CI, −16.6 to −7.1, P < 0.001). In patients without recanalization, the small volumes of salvaged penumbra volume did not save DALY-days (β = −4.1, 95% CI, −9.4−1.2, P = 0.128). (C) Each minute reduction in onset-to-treatment time resulted in a saving of 4.4 DALY-days after stroke (β = 4.4, 95% CI, 1.3–7.5, P = 0.006). In patients with recanalization, each 1 min decrease in onset-to-treatment time saved 10.9 DALY-days (β = 10.9, 95% CI, 5.1–16.7 days, P < 0.001). In those without recanalization, reduction in onset-to-treatment time did not save DALY-days (β = 1.2, 95% CI, −3.1– 5.4, P = 0.589). (D) Each point increase of baseline NIHSS score resulted in an increase of 98.9 days of DALY lost (β = 98.9, 95% CI, 67.2–130.7 days, P < 0.001). In patients with recanalization, each point increase of baseline NIHSS score resulted in an increase of 77.7 DALY-days (β = 77.7, 95% CI, 11.4–144.0, P = 0.022). The effect was even stronger in patients without recanalization, with 128.2 days of DALY lost (β = 128.2, 95% CI, 85.4–171.0 days, P < 0.001).
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aww338-F1: Relationship between disability adjusted life-days, baseline penumbra volume (A), salvaged penumbra volume (B), onset-to-treatment time (C) and baseline NIHSS score (D) in all patients, patients with recanalization, and patients with poor recanalization. (A) Patients lost 4.1 DALY-days per 1 ml baseline penumbra (β = 4.1, 95% CI, 0.8–7.5 days, P = 0.015). In patients with recanalization, baseline penumbra volume did not affect the DALY-days lost due to stroke (β = 0.7, 95% CI, −4.8–13.5 days, P = 0.808). However, patients without recanalization lost 7.5 DALY-days per 1 ml of baseline penumbra (β = 7.5, 95% CI, 2.8–12.3, P = 0.002). (B) Each 1 ml of salvaged penumbra resulted in a saving of 7.2 DALY-days (β = −7.2, 95% CI, −10.4 to −4.1, P < 0.001). In patients with recanalization, each 1 ml of salvaged penumbra resulted in a saving of 11.8 DALY-days (β = −11.8, 95% CI, −16.6 to −7.1, P < 0.001). In patients without recanalization, the small volumes of salvaged penumbra volume did not save DALY-days (β = −4.1, 95% CI, −9.4−1.2, P = 0.128). (C) Each minute reduction in onset-to-treatment time resulted in a saving of 4.4 DALY-days after stroke (β = 4.4, 95% CI, 1.3–7.5, P = 0.006). In patients with recanalization, each 1 min decrease in onset-to-treatment time saved 10.9 DALY-days (β = 10.9, 95% CI, 5.1–16.7 days, P < 0.001). In those without recanalization, reduction in onset-to-treatment time did not save DALY-days (β = 1.2, 95% CI, −3.1– 5.4, P = 0.589). (D) Each point increase of baseline NIHSS score resulted in an increase of 98.9 days of DALY lost (β = 98.9, 95% CI, 67.2–130.7 days, P < 0.001). In patients with recanalization, each point increase of baseline NIHSS score resulted in an increase of 77.7 DALY-days (β = 77.7, 95% CI, 11.4–144.0, P = 0.022). The effect was even stronger in patients without recanalization, with 128.2 days of DALY lost (β = 128.2, 95% CI, 85.4–171.0 days, P < 0.001).

Mentions: In patients with recanalization, baseline penumbra volume did not affect the DALY-days lost due to stroke (non-significant loss of 0.7 DALY-days, 95% CI, –4.8–13.5 days, P = 0.808, Fig. 1A). However, patients without recanalization lost 7.5 DALY-days per 1 ml of baseline penumbra (95% CI, 2.8–12.3, P = 0.002, Fig. 1A). Thus, lack of recanalization markedly affected the extent of baseline penumbra progressing to infarction, and hence led to substantially more DALY-days lost.Figure 1


Perfusion computed tomography in patients with stroke thrombolysis
Relationship between disability adjusted life-days, baseline penumbra volume (A), salvaged penumbra volume (B), onset-to-treatment time (C) and baseline NIHSS score (D) in all patients, patients with recanalization, and patients with poor recanalization. (A) Patients lost 4.1 DALY-days per 1 ml baseline penumbra (β = 4.1, 95% CI, 0.8–7.5 days, P = 0.015). In patients with recanalization, baseline penumbra volume did not affect the DALY-days lost due to stroke (β = 0.7, 95% CI, −4.8–13.5 days, P = 0.808). However, patients without recanalization lost 7.5 DALY-days per 1 ml of baseline penumbra (β = 7.5, 95% CI, 2.8–12.3, P = 0.002). (B) Each 1 ml of salvaged penumbra resulted in a saving of 7.2 DALY-days (β = −7.2, 95% CI, −10.4 to −4.1, P < 0.001). In patients with recanalization, each 1 ml of salvaged penumbra resulted in a saving of 11.8 DALY-days (β = −11.8, 95% CI, −16.6 to −7.1, P < 0.001). In patients without recanalization, the small volumes of salvaged penumbra volume did not save DALY-days (β = −4.1, 95% CI, −9.4−1.2, P = 0.128). (C) Each minute reduction in onset-to-treatment time resulted in a saving of 4.4 DALY-days after stroke (β = 4.4, 95% CI, 1.3–7.5, P = 0.006). In patients with recanalization, each 1 min decrease in onset-to-treatment time saved 10.9 DALY-days (β = 10.9, 95% CI, 5.1–16.7 days, P < 0.001). In those without recanalization, reduction in onset-to-treatment time did not save DALY-days (β = 1.2, 95% CI, −3.1– 5.4, P = 0.589). (D) Each point increase of baseline NIHSS score resulted in an increase of 98.9 days of DALY lost (β = 98.9, 95% CI, 67.2–130.7 days, P < 0.001). In patients with recanalization, each point increase of baseline NIHSS score resulted in an increase of 77.7 DALY-days (β = 77.7, 95% CI, 11.4–144.0, P = 0.022). The effect was even stronger in patients without recanalization, with 128.2 days of DALY lost (β = 128.2, 95% CI, 85.4–171.0 days, P < 0.001).
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aww338-F1: Relationship between disability adjusted life-days, baseline penumbra volume (A), salvaged penumbra volume (B), onset-to-treatment time (C) and baseline NIHSS score (D) in all patients, patients with recanalization, and patients with poor recanalization. (A) Patients lost 4.1 DALY-days per 1 ml baseline penumbra (β = 4.1, 95% CI, 0.8–7.5 days, P = 0.015). In patients with recanalization, baseline penumbra volume did not affect the DALY-days lost due to stroke (β = 0.7, 95% CI, −4.8–13.5 days, P = 0.808). However, patients without recanalization lost 7.5 DALY-days per 1 ml of baseline penumbra (β = 7.5, 95% CI, 2.8–12.3, P = 0.002). (B) Each 1 ml of salvaged penumbra resulted in a saving of 7.2 DALY-days (β = −7.2, 95% CI, −10.4 to −4.1, P < 0.001). In patients with recanalization, each 1 ml of salvaged penumbra resulted in a saving of 11.8 DALY-days (β = −11.8, 95% CI, −16.6 to −7.1, P < 0.001). In patients without recanalization, the small volumes of salvaged penumbra volume did not save DALY-days (β = −4.1, 95% CI, −9.4−1.2, P = 0.128). (C) Each minute reduction in onset-to-treatment time resulted in a saving of 4.4 DALY-days after stroke (β = 4.4, 95% CI, 1.3–7.5, P = 0.006). In patients with recanalization, each 1 min decrease in onset-to-treatment time saved 10.9 DALY-days (β = 10.9, 95% CI, 5.1–16.7 days, P < 0.001). In those without recanalization, reduction in onset-to-treatment time did not save DALY-days (β = 1.2, 95% CI, −3.1– 5.4, P = 0.589). (D) Each point increase of baseline NIHSS score resulted in an increase of 98.9 days of DALY lost (β = 98.9, 95% CI, 67.2–130.7 days, P < 0.001). In patients with recanalization, each point increase of baseline NIHSS score resulted in an increase of 77.7 DALY-days (β = 77.7, 95% CI, 11.4–144.0, P = 0.022). The effect was even stronger in patients without recanalization, with 128.2 days of DALY lost (β = 128.2, 95% CI, 85.4–171.0 days, P < 0.001).
Mentions: In patients with recanalization, baseline penumbra volume did not affect the DALY-days lost due to stroke (non-significant loss of 0.7 DALY-days, 95% CI, –4.8–13.5 days, P = 0.808, Fig. 1A). However, patients without recanalization lost 7.5 DALY-days per 1 ml of baseline penumbra (95% CI, 2.8–12.3, P = 0.002, Fig. 1A). Thus, lack of recanalization markedly affected the extent of baseline penumbra progressing to infarction, and hence led to substantially more DALY-days lost.Figure 1

View Article: PubMed Central - PubMed

ABSTRACT

See Saver (doi:10.1093/awx020) for a scientific commentary on this article.

The extent to which CT perfusion imaging variables before and after reperfusion therapy for stroke predict the length of subsequent disability-free life is unclear. Kawano et al. show that saving a millilitre of penumbra translates into benefits equivalent to more than a week of disability-free life.

No MeSH data available.


Related in: MedlinePlus