Selected aspects of acute stroke treatment in the scope of computed tomographic perfusion imaging : From extended time window to acute treatment and functional outcome

Computed tomographic perfusion (CTP) imaging can depict the salvageable penumbra and the infarcted ischemic core. We evaluated selected aspects of CTP in the treatment of acute ischemic stroke (AIS) in the retrospective data from the Helsinki Stroke Quality Registry. Whether hyperglycemia is a surrogate marker of an acute stress response in AIS, remains unclear. In Study I, out of a total of 832 consecutive stroke patients evaluated as candidates for reperfusion therapy, from 3/2018 to 10/2020, 222 (27 %) were hyperglycemic. In the nondiabetic patients (643, 77%), higher admission glucose level was associated with both larger hypoperfusion lesion, regression coefficient (RC) 4.8 (95% confidence interval 0.49-9.1), and larger ischemic core, RC 2.6 (0.64-4.6). However, no associations were found in diabetic patients. Data on intravenous thrombolysis (IVT) prior to endovascular thrombectomy (EVT) in the extended time window remains scarce. In Study II, we compared 134 consecutive patients in the extended time window, from 1/2021 to 12/2022, with 134 matched controls in the early time window, from 1/2016 to 12/2020. A non-significant shift towards better outcome was found in patients in the extended time window. In patients with IVT and EVT, the adjusted odds ratio (aOR) was 1.15 (0.54-2.43). The rate of sICH did not differ, aOR 0.96 (0.14-6.87). We found no evidence to suggest that IVT or EVT should be omitted in eligible patients in the extended time window, but randomized trials are warranted. Infarct growth rate varies between individuals. We aimed to evaluate whether CTP parameters predict functional outcomes independent of time from stroke onset to reperfusion therapy. In Study III, we identified 948 consecutive patients, who underwent CTP imaging and received IVT and/or EVT, from 1/2016 to 12/2023. Both larger ischemic core volume, aOR 5.0 (3.03-8.33) and longer onset-to-treatment time, aOR 1.20 (1.14-1.28) were associated with worse 3-month outcome. Comparable associations were observed in IVT-only patients and in EVT patients with or without IVT, with successful reperfusion. However, there was no association between larger penumbra and worse outcome, aOR 1.06 (0.86-1.32). Perfusion imaging and stroke quality registries may provide valuable information for future randomized trials and thus contribute to the development of treatment of acute stroke.