London, United Kingdom 2013 Table Independent predictors of poor outcomes in acute ischemic stroke patients Poor outcomes Predictors β SE P value 90 day mRS >2 Age -0.100 0.044 0.023 Baseline -0.208 0.090 0.020 NIHSS rFTD -0.357 0.169 0.034 90 day death Age -0.235 0.098 0.017 E-Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 259 Baseline NIHSS -0.244 0.127 0.054 rFTD -0.792 0.384 0.023 24hr AS-PECTS ≤ 7 Age 0.063 0.034 0.064 Baseline -0.099 0.063 0.118 NIHSS rFTD -0.391 0.15 0.009 Figure A 67 yrs old woman with left sided weakness, facial droop and aphasia presented to hospital 2 hours after onset. CTA identified a right intracranial ICA occlusion. CTP-SI showed the contrast appeared in sylvan fissure (in the black circles) was detected at 7:21:54 pm in the normal hemi-sphere (left) and at 7:22:01pm in the affected hemisphere (right). The rFTD was 7 seconds by sub-tracting the time points. 5 Vascular imaging Relative Filling Time Delay based on CT Perfusion Source Imaging: A Simple Method to Pre-dict Outcome in Acute Ischemic Stroke W. Cao1, B.C. Campbell2, Q Dong3, S.M. Davis4, B. Yan5 Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, AUSTRALIA1, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, AUSTRALIA2, Department of Neurology, Huashan Hospital, Fudan University, Shang-hai, CHINA3, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Mel-bourne, AUSTRALIA4, Melbourne Brain Centre, Royal Melbourne Hospital, University of Mel-bourne, Melbourne, AUSTRALIA5 Background Collateral vessel status is strongly associated with clinical outcome in ischemic stroke but can be challenging to assess. We hypothesized that delayed filling of the middle cerebral artery (MCA) in the Sylvian fissure via collateral vessels would be associated with poorer radiologic and clinical outcome after ischemic stroke. We used a simple visual assessment of this delay relative to the normal contralateral MCA based on CT perfusion source imaging (CTP-SI). Methods Consec-utive ischemic stroke patients who received IV +/- IA reperfusion therapies after CTP at a single centre were retrospectively analyzed using prospectively collected data. In those with baseline MCA or internal carotid artery (ICA) occlusion, CTP-SI was used to identify the relative filling time delay (rFTD) between the normal MCA Sylvian branches and those in the affected hemisphere. Receiver operating characteristic (ROC) and logistic regression (adjusted for baseline age and NIHSS) were used to assess association of rFTD with 24hr Alberta Stroke Program Early CT Score (ASPECTS) based on noncontrast CT and 90 day modified Rankin Scale (mRS). Results There were 217 patients treated in 2009-2011 with CTP-SI data of whom 60 (mean age 70±10yr) had MCA or ICA occlu-sion, 53 had 90 day mRS data. In ROC analysis, increased rFTD was associated with poorer 24hr ASPECTS (area under curve AUC=0.745, 95%CI 0.62-0.87, p=0.002) and poor functional out-come (mRS3-6), (AUC=0.73, 95%CI 0.59-0.86, p=0.006). In multivariate logistic regression this association remained significant independent of age and baseline NIHSS (24hr ASPECTS: rFTD OR=-0.391, p=0.009; day 90 mRS3-6: rFTD OR=-0.357, p=0.034). A threshold of rFTD≥4sec had strong positive predictive value 0.83 for poor outcome (mRS3-6). Longer median rFTD was signifi-cantly associated with ASPECTS≤7 on 24hr CT (p=0.002), mRS3-6 (p=0.005) and death (p=0.004). rFTD was correlated with the baseline NIHSS (Spearman’s rho=0.323, p=0.014), 24hr ASPECTS (rho=-0.516, p=0.000) and 90 day mRS (rho=0.47, p=0.001). Conclusion rFTD may be a useful marker to independently predict clinical and radiologic outcomes after ischemic stroke.
Karger_ESC London_2013
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