CT Helps Select Acute Stroke Patients for Therapy

A study has found that xenon-enhanced computed tomography (XeCT) cerebral blood flow (CBF) and/or CT angiography (CTA) in conjunction with CT can distinguish subgroups of acute ischemic stroke victims and help predict the subgroups most likely to benefit from thrombolytic therapy. The study, conducted by researchers at the University of Pittsburgh (PA, USA), was published in the November 2001 issue of Stroke.

Although tissue plasminogen activator (tPA) is an effective therapy for acute-stroke patients, only a small number are eligible to receive the treatment based on current criteria. Most patients are excluded because they arrive at the hospital too late, beyond the three-hour limit. Now, with the development of new imaging technologies, information on the location of occlusions and a quantitative measure of cerebral blood blow can be gathered within a short time and used to make treatment decisions.

The study involved 51 patients who had a CT, CTA, and stable XeCT-CBF. The results showed that the combination of information obtained by these modalities can determine which patients with acute stroke will be most likely to benefit from aggressive treatment. The researchers say their data suggested that up to six hours and even between six and 24 hours, there are patients (15%) with no infarction on the initial CT and reversible ischemia by CBF criteria and/or an occluded CTA that exhibit infarction on follow-up. This group may benefit from the tPA therapy now offered only to patients who can meet the three-hour deadline. The researchers say a prospective study with more patients is needed to confirm their findings.




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