Please use this identifier to cite or link to this item: https://repository.monashhealth.org/monashhealthjspui/handle/1/52670
Title: Determinants of infarct progression and perfusion core growth in transferred LVO patients from remote regions.
Authors: Valente M.;Bivard A.;Yan B.;Davis S.M.;Campbell B.C.V.;Mitchell P.J.;Ma H. ;Parsons M.W.
Monash Health Department(s): Neurology
Institution: (Valente, Bivard, Yan, Davis, Campbell) Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
(Valente, Ma) Department of Neurology, Monash Health, Clayton, VIC, Australia
(Mitchell) Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
(Parsons) Department of Neurology, South Western Sydney Clinical School, Ingham Institute of Applied Medical Research, Liverpool Hospital, University of New South Wales, Liverpool, NSW, Australia
Issue Date: 15-Oct-2024
Copyright year: 2024
Publisher: Frontiers Media SA
Place of publication: Switzerland
Publication information: Frontiers in Neurology. 15(no pagination), 2024. Article Number: 1476796. Date of Publication: 2024.
Journal: Frontiers in Neurology
Abstract: Introduction: Repeat imaging when regional and remote stroke patients arrive at a comprehensive stroke center (CSC) can delay endovascular thrombectomy (EVT). We examined which clinical and imaging parameters predict infarct progression and perfusion core growth during transport. Method(s): We included patients recruited from 2017 to 2023 in a prospective database who were transferred from remote sites with large vessel occlusion, had CT perfusion imaging at the primary stroke center (PSC), and had repeat CT on arrival at the CSC demonstrating persistent occlusion. The key imaging characteristics were perfusion core change (rCBF < 30%) and ASPECTS change. Multiple and ordinal logistic regression analyses were used to assess the relationship between background clinical and imaging variables and the CT-perfusion core and ASPECTS on arrival. DEFUSE 3 criteria (ASPECTS >= 6, perfusion core < 70 mL) were used to define "favorable imaging." Results: In 90 patients with CT perfusion at both PSC and CSC and persistent occlusion, the median time from onset to PSC presentation was 279 min (IQR 143-702). The median time from PSC presentation to CSC arrival was 243.5 min (IQR 186-335), and the median distance traveled was 186.5 km (IQR 101-258). Lower baseline ASPECTS (per point) was associated with a 7 mL increase (95%CI 2-11 mL) in perfusion core between scans (p = 0.004). The time from onset, the time between PSC and CSC, and the distance traveled were not significantly associated with either ASPECTS or perfusion core growth during transport. In total, 11 out of 78 patients (14%) had deterioration of initially favorable imaging profiles during transport. Conclusion(s): Perfusion core growth during transport was uncommon and most strongly associated with lower ASPECTS at the PSC. Initially, favorable PSC imaging May predict whether repeat imaging is necessary at the CSC.Copyright © 2024 Valente, Bivard, Yan, Davis, Campbell, Mitchell, Ma and Parsons.
DOI: https://dx.doi.org/10.3389/fneur.2024.1476796
URI: https://repository.monashhealth.org/monashhealthjspui/handle/1/52670
Type: Article
Subjects: blood vessel occlusion
brain blood flow
brain ischemia
computer assisted tomography
percutaneous thrombectomy
perfusion
stroke patient
thrombectomy
Type of Clinical Study or Trial: Observational study (cohort, case-control, cross sectional, or survey)
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