Leukoaraiosis May Confound the Interpretation of CT Perfusion in Patients Treated with Mechanical Thrombectomy for Acute Ischemic Stroke

REFERENCES

1. 1.↵
   2. Donnan GA,
   3. Davis SM

   . Neuroimaging, the ischaemic penumbra, and selection of patients for acute stroke therapy. Lancet Neurol 2002;1:417–25 doi:10.1016/S1474-4422(02)00189-8 pmid:12849364

   CrossRefPubMedWeb of Science
2. 2.↵
   2. Dani KA,
   3. Thomas RG,
   4. Chappell FM, et al

   ; Translational Medicine Research Collaboration Multicentre Acute Stroke Imaging Study. Computed tomography and magnetic resonance perfusion imaging in ischemic stroke: definitions and thresholds. Ann Neurol 2011;70:384–401 doi:10.1002/ana.22500 pmid:21796665

   CrossRefPubMed
3. 3.↵
   2. Etherton MR,
   3. Barreto AD,
   4. Schwamm LH, et al

   . Neuroimaging paradigms to identify patients for reperfusion therapy in stroke of unknown onset. Front Neurol 2018;9:327 doi:10.3389/fneur.2018.00327 pmid:29867736

   CrossRefPubMed
4. 4.↵
   2. Vilela P,
   3. Rowley HA

   . Brain ischemia: CT and MRI techniques in acute ischemic stroke. Eur J Radiol 2017;96:162–72 doi:10.1016/j.ejrad.2017.08.014 pmid:29054448

   CrossRefPubMed
5. 5.↵
   2. Donahue J,
   3. Wintermark M

   . Perfusion CT and acute stroke imaging: foundations, applications, and literature review. J Neuroradiol 2015;42:21–29 doi:10.1016/j.neurad.2014.11.003 pmid:25636991

   CrossRefPubMed
6. 6.↵
   2. Heit JJ,
   3. Wintermark M

   . Perfusion computed tomography for the evaluation of acute ischemic stroke: strengths and pitfalls. Stroke 2016;47:1153–58 doi:10.1161/STROKEAHA.116.011873 pmid:26965849

   FREE Full Text
7. 7.↵
   2. Ramli N,
   3. Ho K,
   4. Nawawi O, et al

   . CT perfusion as a useful tool in the evaluation of leuko-araiosis. Biomed Imaging Interv J 2006;2:e16 doi:10.2349/biij.2.2.e16 pmid:21614226

   CrossRefPubMed
8. 8.↵
   2. Chen C,
   3. Bivard A,
   4. Lin L, et al

   . Thresholds for infarction vary between gray matter and white matter in acute ischemic stroke: a CT perfusion study. J Cereb Blood Flow Metab 2019;39:536–46 doi:10.1177/0271678X17744453 pmid:29172990

   CrossRefPubMed
9. 9.↵
   2. Sakai Y,
   3. Delman BN,
   4. Fifi JT, et al

   . Estimation of ischemic core volume using computed tomographic perfusion. Stroke 2018;49:2345–52 doi:10.1161/STROKEAHA.118.021952 pmid:30355089

   CrossRefPubMed
10. 10.↵
    2. Vagal A,
    3. Aviv R,
    4. Sucharew H, et al

    . Collateral clock is more important than time clock for tissue fate. Stroke 2018;49:2102–07 doi:10.1161/STROKEAHA.118.021484 pmid:30354992

    CrossRefPubMed
11. 11.↵
    2. Østergaard L,
    3. Jespersen SN,
    4. Mouridsen K, et al

    . The role of the cerebral capillaries in acute ischemic stroke: the extended penumbra model. J Cereb Blood Flow Metab 2013;33:635–48 doi:10.1038/jcbfm.2013.18 pmid:23443173

    CrossRefPubMed
12. 12.↵
    2. Higashida RT,
    3. Furlan AJ,
    4. Roberts H, et al

    ; Technology Assessment Committee of the American Society of Interventional and Therapeutic Neuroradiology, Technology Assessment Committee of the Society of Interventional Radiology. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke 2003;34:e109–37 pmid:12869717

    Abstract/FREE Full Text
13. 13.↵
    2. Arba F,
    3. Mair G,
    4. Carpenter T, et al

    ; IST-3 Trial Collaborators. Cerebral white matter hypoperfusion increases with small-vessel disease burden: data from the Third International Stroke Trial. J Stroke Cerebrovasc Dis 2017;26:1506–13 doi:10.1016/j.jstrokecerebrovasdis.2017.03.002 pmid:28314624

    CrossRefPubMed
14. 14.↵
    2. Zaidat OO,
    3. Lazzaro MA,
    4. Liebeskind DS, et al

    . Revascularization grading in endovascular acute ischemic stroke therapy. Neurology 2012;79:S110–16 doi:10.1212/WNL.0b013e3182695916 pmid:23008384

    CrossRefPubMed
15. 15.↵
    2. Rudilosso S,
    3. Urra X,
    4. San Román L, et al

    . Perfusion deficits and mismatch in patients with acute lacunar infarcts studied with whole-brain CT perfusion. AJNR Am J Neuroradiol 2015;36:1407–12 doi:10.3174/ajnr.A4303 pmid:25882287

    Abstract/FREE Full Text
16. 16.↵
    2. Fazekas F,
    3. Chawluk JB,
    4. Alavi A, et al

    . MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. AJR Am J Roentgenol 1987;149:351–56 doi:10.2214/ajr.149.2.351 pmid:3496763

    CrossRefPubMedWeb of Science
17. 17.↵
    2. Rosner B

    . Fundamentals of Biostatistics. 6th ed. Thomson: Brooks/Cole; 2006
18. 18.↵
    2. Yu Y,
    3. Han Q,
    4. Ding X, et al

    . Defining core and penumbra in ischemic stroke: a voxel- and volume-based analysis of whole brain CT perfusion. Sci Rep 2016;6:20932 doi:10.1038/srep20932 pmid:26860196

    CrossRefPubMed
19. 19.↵
    2. Lin L,
    3. Bivard A,
    4. Krishnamurthy V, et al

    . Whole-brain CT perfusion to quantify acute ischemic penumbra and core. Radiology 2016;279:876–87 doi:10.1148/radiol.2015150319 pmid:26785041

    CrossRefPubMed
20. 20.↵
    2. Campbell BC,
    3. Christensen S,
    4. Levi CR, et al

    . Cerebral blood flow is the optimal CT perfusion parameter for assessing infarct core. Stroke 2011;42:3435–40 doi:10.1161/STROKEAHA.111.618355 pmid:21980202

    Abstract/FREE Full Text
21. 21.↵
    2. Wardlaw JM,
    3. Smith C,
    4. Dichgans M

    . Small vessel disease: mechanisms and clinical implications. Lancet Neurol 2019;18:684–96 doi:10.1016/S1474-4422(19)30079-1 pmid:31097385

    CrossRefPubMed
22. 22.↵
    2. Wardlaw JM,
    3. Doubal FN,
    4. Valdes-Hernandez M, et al

    . Blood-brain barrier permeability and long-term clinical and imaging outcomes in cerebral small vessel disease. Stroke 2013;44:525–27 doi:10.1161/STROKEAHA.112.669994 pmid:23233386

    Abstract/FREE Full Text
23. 23.↵
    2. Giurgiutiu DV,
    3. Yoo AJ,
    4. Fitzpatrick K, et al

    . Severity of leukoaraiosis, leptomeningeal collaterals, and clinical outcomes after intra-arterial therapy in patients with acute ischemic stroke. J Neurointerv Surg 2015;7:326–30 doi:10.1136/neurintsurg-2013-011083 pmid:24721756

    Abstract/FREE Full Text
24. 24.↵
    2. Shi Y,
    3. Thrippleton MJ,
    4. Blair GW, et al

    . Small vessel disease is associated with altered cerebrovascular pulsatility but not resting cerebral blood flow. J Cereb Blood Flow Metab 2018 Oct 8:271678X18803956. [Epub ahead of print] doi:10.1177/0271678X18803956 pmid:30295558

    CrossRefPubMed
25. 25.↵
    2. Østergaard L,
    3. Engedal TS,
    4. Moreton F, et al

    . Cerebral small vessel disease: capillary pathways to stroke and cognitive decline. J Cereb Blood Flow Metab 2016;36:302–25 doi:10.1177/0271678X15606723 pmid:26661176

    CrossRefPubMed
26. 26.↵
    2. Rudilosso S,
    3. San Román L,
    4. Blasco J, et al

    . Evaluation of white matter hypodensities on computed tomography in stroke patients using the Fazekas score. Clin Imaging 2017;46:24–27 doi:10.1016/j.clinimag.2017.06.011 pmid:28688243

    CrossRefPubMed
27. 27.↵
    2. Ferguson KJ,
    3. Cvoro V,
    4. MacLullich AM, et al

    . Visual rating scales of white matter hyperintensities and atrophy: comparison of computed tomography and magnetic resonance imaging. J Stroke Cerebrovasc Dis 2018;27:1815–21 doi:10.1016/j.jstrokecerebrovasdis.2018.02.028 pmid:29576397

    CrossRefPubMed
28. 28.↵
    2. Albers GW,
    3. Marks MP,
    4. Kemp S, et al

    ; DEFUSE 3 Investigators. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018;378:708–18 doi:10.1056/NEJMoa1713973 pmid:29364767

    CrossRefPubMed
29. 29.↵
    2. Nogueira RG,
    3. Jadhav AP,
    4. Haussen DC, et al

    ; DAWN Trial Investigators. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018;378:11–21 doi:10.1056/NEJMoa1706442 pmid:29129157

    CrossRefPubMed
30. 30.↵
    2. Thomalla G,
    3. Simonsen CZ,
    4. Boutitie F, et al

    ; WAKE-UP Investigators. MRI-guided thrombolysis for stroke with unknown time of onset. N Engl J Med 2018;379:611–22 doi:10.1056/NEJMoa1804355 pmid:29766770

    CrossRefPubMed
31. 31.↵
    2. Bathla G,
    3. Limaye K,
    4. Policeni B, et al

    . Achieving comparable perfusion results across vendors: the next step in standardizing stroke care: a technical report. J Neurointerv Surg 2019 May 22. [Epub ahead of print] doi:10.1136/neurintsurg-2019-014810 pmid:31118267

    Abstract/FREE Full Text
32. 32.↵
    2. Laredo C,
    3. Renú A,
    4. Tudela R, et al

    . The accuracy of ischemic core perfusion thresholds varies according to time to recanalization in stroke patients treated with mechanical thrombectomy: a comprehensive whole-brain computed tomography perfusion study. J Cereb Blood Flow Metab 2019 Jun 17:271678X19855885. [Epub ahead of print] doi:10.1177/0271678X19855885 pmid:31208242

    CrossRefPubMed
33. 33.
    2. Adams HP Jr.,
    3. Bendixen BH,
    4. Kappelle LJ, et al

    . Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35–41 doi:10.1161/01.str.24.1.35 pmid:7678184

    Abstract/FREE Full Text