CT-Perfusion in ischemic stroke: prediction of the ASPECTS's outcomes through the scores of core and penumbra

• Autor(a) principal: Monteiro, Ana Carreira
• Data de Publicação: 2021
• Outros Autores: Striyenku, Karina, Ferreira, Nuno Poças, Cacito, André Silva, Brito, Catarina Borges, Fonseca, Hugo Miguel, Antunes, Edgar Coelho, Carolino, Elisabete, Ribeiro, Margarida
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://doi.org/10.25758/set.2275
• topic: Tomografia computorizada de perfusão; ASPECTS; Acidente vascular cerebral; Fluxo sanguíneo cerebral; Penumbra; Core; Trombectomia; Computed tomography perfusion; Stroke; ASPECTS; Cerebral blood volume; Penumbra; Core; Thrombectomy

Introduction – According to the 2017 Portuguese Program for Cardio-Cerebrovascular Diseases, the OECD reports that cardiovascular diseases are the leading cause of death in member states of the European Union, representing about 36% of deaths in the region in 2010. This figure includes brain vascular diseases. It was intended to evaluate the value of cerebral blood flow (CBF) that best predicts the outcomes from the Via Verde procedure in stroke, with patients undergoing thrombectomy. It was also purpose of this study to increase the reliability of prognosis, optimizing the technique and radiological procedures for determining volumes of ‘core’ and ‘penumbra’. Methods – This was a retrospective study whose clinical cases were collectedfrom the database of Hospital de Beatriz Ângelo (Loures, PT) based on predefined inclusion criteria. After the acquisition of perfusion computed tomography (PCT), a sample of 17 patients, admitted through the Via Verde stroke program, was post-processed using the syngo.via software (NEURO Perfusion application). The data resulting from the perfusion maps were analyzed statistically using the SPSS® [IBM v. 23.0], allowing an analysis that reflected the CBF values related to thevolumes of ‘core’ and ‘penumbra’. Results – It was found that there is no statistically significant correlation between age, stroke time extends, and pre-therapeutic ASPECTS with the other variables under study. Relating the post-therapeutic ASPECTS to the core levels 10, 20, and 30 of CBF, it was found that the higher value of ASPECTS corresponds lower volume of the core. A statistically significant reduction (p=0.003) of the ASPECTS values was detected from pre- to post-therapy. The ‘core’ 10CBF value presents a lower volume of brain tissue infarcted in relation to the ‘core’ 30CBF, pointing to an inverse trend with the value of ‘penumbra’ volume. Conclusion – This study proves that it is possible, with a CBF of 10mL / 100g / min, to restore the flow needed to repair the neurological function of affected tissue, and with this CBF the largest volume of brain tissue isobtained for the ‘penumbra’ and a lower volume of ‘core’. The processing and interpretation of the perfusion maps induce variation in the volume of the score of ‘core’ and ‘penumbra’.