22. European Stroke Conference 215 Vascular imaging CT Perfusion Source Images: A reliable modality to assess the status of antegrade flow across an intracranial occlusion S. Mishra1, B. Menon2, A. Demchuk3 Calgary Stroke Program, Foothills Medical Centre, University of Calgary, Calgary, CANA-DA1, Calgary Stroke Program, Foothills Medical Centre, University of Calgary, Calgary, CANA-DA2, Calgary Stroke Program, Foothills Medical Centre, University of Calgary, Calgary, CANADA3 Background: Antegrade flow across occlusion identified on 4-dimensional CT Angiography (CTA) predicts early recanalization with IV tPA (Frolich et al, Stroke 2012). However, 4-dimensional CTA takes time to process and interpret and is not possible on some current CT systems. We tried to look if CT Perfu-sion Source Images (CTPSI) can provide this information with rapidity and correlated with DSA. Methods: From prospective database, we selected patients with acute ischemic stroke and intracranial occlu-sion on CTA who had a CT Perfusion study followed by DSA. CT Perfusion parameters were 8 cm coverage in static mode, acquisitions at 5 mm thickness, 5 seconds delay after contrast & 24 passes over 66 seconds. Antegrade flow was defined as contrast permeating the clot and filling the vessel distal to the occlusion on the 1st or 2nd pass of CTPSI, which represented early arterial phase and the contrast still had not opacified the venous system. This was further confirmed measuring HU at the arterial segment proximal to the occlusion (HU 100-200) and the confluence of deep cerebral veins in midline (no contrast or HU<100). Antegrade flow was correlated with the first run of DSA. Results: Twenty six patients were included. Median NIHSS was 16. Median time from CT Perfusion to DSA first run was 56 minutes. All patients received IV tPA. On CTPSI, antegrade flow was present in 8/26 (31%). All 8 subjects with antegrade flow on CTPSI had forward perfusion on first angio run (TICI 2a 4; TICI2b 4). All but one subjects without ante-grade flow on CTPSI had no forward perfusion (TICI0 – 17/18) (Image 1&2). Only one patient had an absent antegrade flow on CTPSI and showed TICI 2b flow on DSA. Sensitivity and specificity of CTPSI to predict antegrade flow compared to DSA was 88% (95% CI, 51%-99%) and 100% (95% CI, 77%-100%) respectively. The positive predictive value was 100% (95% CI, 60%-100%). Conclusion: Antegrade flow across an occlusion can be reliably and rapidly assessed on CTPSI. 398 © 2013 S. Karger AG, Basel Scientific Programme
Karger_ESC London_2013
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