Background and Aims
Cerebral infarction core can be assessed using CT-Perfusion cerebral blood volume maps(CBV-core). However, no study has evaluated the CBV-core changes during stroke progression yet. The CT-RITMO(CT-Perfusion Rate of Infarction growTh in MCA ThrOmbectomy) study goal is to evaluate factors related to infarction growth in hyperacute stroke.
We conducted a retrospective study of consecutive patients with MCA acute stroke transferred between 2 stroke centers and undergoing endovascular treatment, from January 2010 to March 2017. CBV-core was estimated in sequential CT-Perfusion(CTP) studies (first CTP performed in the shipping center and a second one in the treatment center). Clinical and radiological variables were correlated with infarction growth.
N= 50. Mean age: 68,4. Women 54 %. Pretreatment NIHSS 16,1(SD 5,8). Successful recanalization in 86%. Median time(minutes) between CTP: 105[90-121]. Collateral circulation: good 64%, moderate 25%, poor 12%. Mean CBV-Core growth 3,5ml(SD 4,6). CBV-core growth: <5 ml 56%, 5-10 ml 12%, 10-15 ml 24%, > 15 ml 8%. Mean CBV-core velocity of growth: 0,03 ml/minute(SD 0,04). We found direct correlation between CBV-core growth and blood glucose levels(Spearman Rho=0,33; p=0,03), creatinine levels(Rho=0,3;p=0,05) and pretreatment NIHSS(Rho=0,28;p=0,05). Better collateral circulation was associated with lower CBV-core growth. Higher CBV-core growth was associated with worse mRS at 3 months(Rho=0,35;p=0,01) and infarction volume at 24h(Rho=0,44 ;p=0,002).
Our study suggests that CBV-core growth tends to be low but with a significant variability. Infarction growth was associated with factors already known as relevant in stroke, but our study points out their importance even for a short period in the hyperacute phase