PT  - JOURNAL ARTICLE
AU  - Ospel, Johanna M.
AU  - Rex, Nathaniel
AU  - Rinkel, Leon
AU  - Kashani, Nima
AU  - Buck, Brian
AU  - Rempel, Jeremy
AU  - Sahlas, Demetrios
AU  - Kelly, Michael E.
AU  - Budzik, Ron
AU  - Tymianski, Michael
AU  - Hill, Michael D.
AU  - Goyal, Mayank
AU - On behalf of the ESCAPE-NA1 Investigators
TI  - Prevalence of “Ghost Infarct Core” after Endovascular Thrombectomy
AID  - 10.3174/ajnr.A8113
DP  - 2024 Mar 01
TA  - American Journal of Neuroradiology
PG  - 291--295
VI  - 45
IP  - 3
4099  - http://www.ajnr.org/content/45/3/291.short
4100  - http://www.ajnr.org/content/45/3/291.full
SO  - Am. J. Neuroradiol.2024 Mar 01; 45
AB  - BACKGROUND AND PURPOSE: Baseline CTP sometimes overestimates the size of the infarct core (“ghost core” phenomenon). We investigated how often CTP overestimates infarct core compared with 24-hour imaging, and aimed to characterize the patient subgroup in whom a ghost core is most likely to occur.MATERIALS AND METHODS: Data are from the randomized controlled ESCAPE-NA1 trial, in which patients with acute ischemic stroke undergoing endovascular treatment were randomized to intravenous nerinetide or placebo. Patients with available baseline CTP and 24-hour follow-up imaging were included in the analysis. Ghost infarct core was defined as CTP core volume minus 24-hour infarct volume > 10 mL). Clinical characteristics of patients with versus without ghost core were compared. Associations of ghost core and clinical characteristics were assessed by using multivariable logistic regression.RESULTS: A total of 421 of 1105 patients (38.1%) were included in the analysis. Forty-seven (11.2%) had a ghost core > 10 mL, with a median ghost infarct volume of 13.4 mL (interquartile range 7.6–26.8). Young patient age, complete recanalization, short last known well to CT times, and possibly male sex were associated with ghost infarct core.CONCLUSIONS: CTP ghost core occurred in ∼1 of 10 patients, indicating that CTP frequently overestimates the infarct core size at baseline, particularly in young patients with complete recanalization and short ischemia duration.AISacute ischemic strokeeTICIexpanded TICIEVTendovascular treatmentLVOlarge vessel occlusionrCBFrelative CBF