Computed Tomography Perfusion Prognostic Maps Do Not Predict Reversible and Irreversible Neurological Dysfunction following Reperfusion Therapies

Abstract

Background We aimed to evaluate the ability of commercially available computed tomography perfusion (CTP) prognostic maps software to identify reversibly and irreversibly damaged brain functions in the best case scenario: patients who achieved early and complete tissue reperfusion. Methods Consecutive ischemic stroke patients who received reperfusion therapies, those with early (less than two-hours from treatment initiation) and complete Thrombolysis in Myocardial Infarction grade III or equivalent reperfusion were included in the analysis. Computed tomography perfusion prognostic maps were assigned as ‘red,’ or irreversible if cerebral blood volume declined below 2 ml/100 g and ‘green,’ or recoverable if the affected/unaffected mean transit time ratio was >1·45. Only patients with middle cerebral artery territory affected were included and subcomponents of the National Institutes of Health Stroke Scale scale pre- and posttreatment were analyzed based on anatomical correlation of the affected CTP areas and corresponding neurological functions. Results Among 109 consecutive patients who had intra-arterial reperfusion procedures, 16 (age 60±17 years, 56% men, median National Institutes of Health Stroke Scale 13·5, interquartile range 7–18) had pretreatment CTP and had early complete reperfusion. We identified 44 affected areas on CTP (red 12 (27%), green 32 (73%)) with corresponding measurable neurological deficits including aphasia, arm, face weakness, and inattention. Red areas correctly identified 5/12 (42%) of functions that did not recover despite early reperfusion. Green areas correctly identified 18/32 (56%) of functions that recover after early reperfusion (OR 0·92, 95% CI 0·25–3·39, P=1·0). Conclusions In-patients achieving early and complete reperfusion, pretreatment CTP prognostic maps were not predictive for irreversibly or reversibly lost neurologic functions.