March 2017

ANNALS of Neurology

Computed Tomographic Perfusion to Predict Response to Recanalization in Ischemic Stroke

Maarten G. Lansberg, MD, PhD, Soren Christensen, PhD, Stephanie Kemp, Michael Mlynash, MD, MS, Nishant Mishra, MD, PhD ,Christian Federau, MD, Jenny P. Tsai, MD, Sun Kim, MD, Raul G. Nogueria, MD, Tudor Jovin, MD, Thomas G. Devlin, MD, Naveed Akhtar, MD, Dileep R. Yavagal, MD, Diogo Haussen, MD, Seena Dehkharghani, MD, Roland Bammer, PhD, Matus Straka, PhD, Greg Zaharchuk, MD, Michael P. Marks, MD, and Gregory W. Albers, MD for the CT Perfusion to Predict Response to Recanalization in Ischemic Stroke Project (CRISP) Investigators

Patients with middle cerebral artery and distal carotid occlusions were randomized to treatment with tPA (tissue-type plasminogen activator) alone or tPA+stentriever thrombectomy. The primary outcome was the distribution of the...

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May 2, 2017

Stroke

Efficacy of Stent-Retriever Thrombectomy in Magnetic Resonance Imaging Versus Computed Tomographic Perfusion–Selected Patients in SWIFT PRIME Trial (Solitaire FR With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke)

Nicolas Menjot de Champfleur, Jeffrey L. Saver, Mayank Goyal, Reza Jahan, Hans-Christoph Diener, Alain Bonafe, Elad I. Levy, Vitor M. Pereira, Christophe Cognard, Dileep R. Yavagal, and Gregory W. Albers

Patients with middle cerebral artery and distal carotid occlusions were randomized to treatment with tPA (tissue-type plasminogen activator) alone or tPA+stentriever thrombectomy. The primary outcome was the distribution of the...

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March 24, 2017

International Journal of Stroke

A multicenter randomized controlled trial of endovascular therapy following imaging evaluation for ischemic stroke (DEFUSE 3)

Gregory W Albers, Maarten G Lansberg, Stephanie Kemp, Jenny P Tsai, Phil Lavori, Soren Christensen, Michael Mlynash, Sun Kim, Scott Hamilton, Sharon D Yeatts, Yuko Palesch, Roland Bammer, Joe Broderick, Michael P Marks

Early reperfusion in patients experiencing acute ischemic stroke is effective in patients with large vessel occlusion. No randomized data are available regarding the safety and efficacy of endovascular therapy beyond 6h from symptom onset...

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February 13, 2017

Stroke

Computed Tomographic Perfusion Selection and Clinical Outcomes After Endovascular Therapy in Large Vessel Occlusion Stroke

Mehdi Bouslama, MD; Diogo C. Haussen, MD; Jonathan A. Grossberg, MD; Seena Dehkharghani, MD; Meredith T. Bowen, BA; Leticia C. Rebello, MD; Nicolas A. Bianchi, MD; Michael R. Frankel, MD; Raul G. Nogueira, MD

Different imaging paradigms have been used to select patients for endovascular therapy in stroke. We sought to determine whether computed tomographic perfusion (CTP) selection improves endovascular therapy outcomes compared with...

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January 13, 2017

Stroke

Predictive Value of RAPID Assessed Perfusion Thresholds on Final Infarct Volume in SWIFT PRIME (Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment)

Maxim Mokin, MD, PhD; Elad I. Levy, MD, MBA; Jeffrey L. Saver, MD; Adnan H. Siddiqui, MD, PhD; Mayank Goyal, MD; Alain Bonafé, MD; Christophe Cognard, MD; Reza Jahan, MD; Gregory W. Albers, MD; for the SWIFT PRIME Investigators

We aimed to analyze the accuracy of various rCBV and rCBF thresholds for predicting the 27-hour infarct volume using RAPID automated analysis software from the SWIFT PRIME trial...

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January 8, 2017

The Lancet Neurology

Changing the face of the stroke stopwatch

Jules Morgan

Treatment for stroke is determined by the stopwatch. Missing the few hours that are the window of opportunity between stroke onset and the time of diagnosis make many patients ineligible for reperfusion therapy, because of concerns that treatment might be too risky or ineffective...

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November 15, 2016

Stroke

Optimal Computed Tomographic Perfusion Scan Duration for Assessment of Acute Stroke Lesion Volumes

Aimen S. Kasasbeh, Søren Christensen, Matus Straka, Nishant Mishra, Michael Mlynash, Roland Bammer, Gregory W. Albers, Maarten G. Lansberg

We retrospectively assessed the impact of gradual truncation of the scan duration on acute ischemic lesion volume measurements. For each scan, we identified its optimal scan time, defined as the shortest scan duration that yields measurements of the ischemic lesion volumes similar to those obtained with longer scanning, and...

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May 3, 2016

Stroke

Comparison of perfusion CT software to predict the final infarct volume after thrombectomy

Friederike Austern, Christian Riedel, Tina Derby, Johannes Meyne, Andreas Binder, Thomas Lindner, Monika Huhndorf, Fritz Wodran, Olav Jansen

Computed tomographic perfusion represents an interesting physiological imaging modality to select patients for reperfusion therapy in acute ischemic stroke. The purpose of our study was to determine the accuracy of different commercial perfusion CT software packages (Philips (A), Siemens (B), and RAPID (C)) to predict the final infarct volume (FIV) after mechanical thrombectomy..

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February 18, 2016

Medscape Medical News

CT Profile Flags Stroke Patients Who May Have More Time

Nancy A. Melville

Stroke patients identified with computed tomography (CT) perfusion as having a distinctive neurologic profile show potential benefits from endovascular interventions well beyond the conventional 6-hour window, new research suggests...

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October 17, 2015

ANNALS of Neurology

Ischemic core and hypoperfusion volumes predict infarct size in SWIFT PRIME.

Albers, Goyal, Jahan, Bonafe, Diener, Levy, Pereira, Cognard, Cohen, Hacke, Jansen, Jovin, Mattle, Nogueira, Siddiqui, Yavagal, Baxter, Devlin, Lopes, Reddy, du Mesnil de Rochemont, Singer, Bammer, Saver.

Within the context of a prospective randomized trial (SWIFT PRIME), we assessed whether early imaging of stroke patients, primary with CT perfusion, can estimate the size of the irreversibly injured ischemic core and the volume of critically hypoperfused tissue. We also evaluated the accuracy of ischemic core and hypoperfusion volumes for predicting infarct volume in patients with the target mismatch profile...

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May 6, 2015

Journal of Cerebral Blood Flow & Metabolism

A benchmarking tool to evaluate computer tomography perfusion infarct core predictions against a DWI standard

Carlo W Cereda, Søren Christensen, Bruce CV Campbell, Nishant K Mishra, Michael Mlynash, Christopher Levi, Matus Straka, Max Wintermark, Roland Bammer, Gregory W Albers, Mark W Parsons and Maarten G Lansberg

Differences in research methodology have hampered the optimization of Computer Tomography Perfusion (CTP) for identification of the ischemic core. We aim to optimize CTP core identification using a novel benchmarking tool. The benchmarking tool consists of an imaging library and a statistical analysis algorithm to evaluate the performance of CTP...

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Jan. 1, 2015

New England Journal of Medicine

Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection

B.C.V. Campbell, P.J. Mitchell, T.J. Kleinig, H.M. Dewey, L. Churilov, N. Yassi, B. Yan, R.J. Dowling, M.W. Parsons, T.J. Oxley, T.Y. Wu, M. Brooks, M.A. Simpson, F. Miteff, C.R. Levi, M. Krause, T.J. Harrington, K.C. Faulder, B.S. Steinfort, M. Priglinger, T. Ang, R. Scroop, P.A. Barber, B. McGuinness, T. Wijeratne, T.G. Phan, W. Chong, R.V. Chandra, C.F. Bladin, M. Badve, H. Rice, L. de Villiers, H. Ma, P.M. Desmond, G.A. Donnan, and S.M. Davis, for the EXTEND-IA Investigators

Trials of endovascular therapy for ischemic stroke have produced variable results. We conducted this study to test whether more advanced imaging selection, recently developed devices, and earlier intervention improve outcomes...

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July 7, 2015

Stroke

Relationships Between Imaging Assessments and Outcomes in Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke

Gregory W. Albers, MD; Mayank Goyal, MD; Reza Jahan, MD; Alain Bonafe, MD; Hans-Christoph Diener, MD; Elad I. Levy, MD, MBA; Vitor M. Pereira, MD; Christophe Cognard, MD; Dileep R. Yavagal, MD; Jeffrey L. Saver, MD

Imaging findings can predict outcomes in patients with acute stroke. Relationships between imaging findings and clinical and imaging outcomes in patients randomized to intravenous tissue-type plasminogen activator–alone versus tissue-type plasminogen activator plus endovascular therapy (Solitaire device) in the Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) study were assessed...

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April 17, 2015

New England Journal of Medicine

Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke

Jeffrey L. Saver, M.D., Mayank Goyal, M.D., Alain Bonafe, M.D., Hans-Christoph Diener, M.D., Ph.D., Elad I. Levy, M.D., Vitor M. Pereira, M.D., Gregory W. Albers, M.D., Christophe Cognard, M.D., David J. Cohen, M.D., Werner Hacke, M.D., Ph.D., Olav Jansen, M.D., Ph.D., Tudor G. Jovin, M.D., Heinrich P. Mattle, M.D., Raul G. Nogueira, M.D., Adnan H. Siddiqui, M.D., Ph.D., Dileep R. Yavagal, M.D., Blaise W. Baxter, M.D., Thomas G. Devlin, M.D., Ph.D., Demetrius K. Lopes, M.D., Vivek K. Reddy, M.D., Richard du Mesnil de Rochemont, M.D., Oliver C. Singer, M.D., and Reza Jahan, M.D., for the SWIFT PRIME Investigators

Among patients with acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, less than 40% regain functional independence when treated with intravenous tissue plasminogen activator (t-PA) alone. Thrombectomy with the use of a stent retriever, in addition to intravenous t-PA, increases reperfusion rates and may improve long-term functional outcome...

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November, 2010

Journal of Magnetic Resonance Imaging

Real-time diffusion-perfusion mismatch analysis in acute stroke

Straka M, Albers GW, Bammer R.

Diffusion-perfusion mismatch can be used to identify acute stroke patients that could benefit from reperfusion therapies. Early assessment of the mismatch facilitates necessary diagnosis and treatment decisions in acute stroke. We developed the RAPID processing of PerfusIon and Diffusion (RAPID) for unsupervised, fully automated processing of perfusion and diffusion data for the purpose of expedited routine clinical assessment...

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May 3, 2016

Wolters Kluwer

MR and CT Perfusion and Pharmacokinetic Imaging: Clinical Applications and Theoretical Principles

Roland Bammer Ph.D

International experts in the field demonstrate how perfusion and pharmacokinetic imaging can be effectively used to analyze medical conditions, helping you reach accurate diagnoses and monitor disease progression and response to therapy...

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November 28, 2012

Stroke

Early Diffusion-Weighted Imaging and Perfusion-Weighted Imaging Lesion Volumes Forecast Final Infarct Size in DEFUSE 2

Hayley M. Wheeler, BS; Michael Mlynash, MD, MS; Manabu Inoue, MD, PhD; Aaryani Tipirneni, MS; John Liggins, BS; Greg Zaharchuk, MD, PhD; Matus Straka, PhD; Stephanie Kemp, BS; Roland Bammer, PhD; Maarten G. Lansberg, MD, PhD; Gregory W. Albers, MD; on behalf of the DEFUSE 2 Investigators

It is hypothesized that early diffusion-weighted imaging (DWI) lesions accurately estimate the size of the irreversibly injured core and thresholded perfusion-weighted imaging (PWI) lesions (time to maximum of tissue residue function [Tmax] >6 seconds) approximate the volume of critically hypoperfused tissue. With incomplete reperfusion, the union of baseline DWI and posttreatment PWI is hypothesized to predict infarct volume....

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