The Overestimated Benign Oligemia of Intracranial Large Artery Disease
Patients in Subacute Phase of Stroke:Quantitative Measurement by Perfusion Computed Tomography
Chinese University of Hong Kong
Background and purpose—Computed tomographic Perfusion (CTP) is used to assess the presence of infarct core/ penumbra mismatch area in the selection of patients for thrombolytic therapy in acute phase of stroke. However, little is known about the mismatch area of intracranial large artery disease (ICAD) in the subacute phase of stroke.
Methods—Consecutive hospitalized ischemic stroke patients who were referred for CTP in 2009 were screened.The ICAD patients with cerebral infarction in MCA territory and CTP results in subacute phase of stroke were included. The CTP films were quantitatively measured. Cerebral blood flow (CBF), CBV, MTT, CBF ratio, CBV ratio and MTT ratio of bilateral MCA territory of the included patients were analysised.
Results—Finally, 14 ICAD patients with a mismatch area in subacute phase of stroke were recruited. In the hypoperfused MCA territory, the median value of CBF, CBF ratio, CBV, CBV ratio, MTT, MTT ratio was 28.25 ml/100g/min, 0.77, 2.04 ml/100g, 1.3, 6.67 s, 1.77 respectively.
Conclusions— The long-lasting mismatch area in subacute phase of stroke suggested the so called “penumbra” in ICAD group was benign oligemia. CTP might overestimate the measurement of risk-to-benefit ratio for thrombolytic therapy, especially in ICAD patients.