Perfusion CT for Selecting Patients with Acute Ischemic Stroke for Intravenous Thrombolytic Therapy

Purpose: To determine rates of death, disability, and symptomatic intracranial hemorrhage (SICH) among patients with acute ischemic stroke selected for thrombolytic therapy by using perfusion computed tomography (CT) by conducting a systematic review and meta-analysis. Materials and Methods: A search of the literature up to July 2012 was performed by using MEDLINE, EMBASE, the Cochrane Library, PubMed, and Google Scholar on terms including "brain ischemia" and "perfusion imaging." The search was unrestricted by language of publication. Two reviewers extracted study data and independently assessed the risk of study bias. Outcomes of patients selected by using perfusion CT, including case-fatality rate, favorable outcome (modified Rankin Scale [mRS] score, <= 2), and rates of SICH, were estimated. Results: Thirteen experimental or observational studies that included patients who received intravenous thrombolytic treatment after perfusion CT were identified. The methodologic quality of the small studies was generally good. Overall, 90-day mortality was 10.0% (95% confidence interval [CI]: 5.4%, 15.9%). Among patients treated within 3 hours of symptom onset, mortality was 12.5% (95% CI: 6.7%, 19.7%), a favorable outcome (mRS score, <= 2) was seen in 42.5% of patients (95% CI: 16.6%, 70.9%), and the SICH rate was 3.3% (95% CI: 0.7%, 7.7%). Among patients treated more than 3 hours after symptom onset, mortality was 2.9% (95% CI: 0.0%, 12.7%), 69.9% of patients (95% CI: 0%, 83.5%) had a favorable outcome, and the SICH rate was 3.9% (95% CI: 0.8%, 9.2%). Conclusion: The outcomes (mortality, morbidity, and SICH rates) for patients selected with perfusion CT to receive intravenous thrombolytic treatment more than 3 hours after symptom onset appear favorable. (C) RSNA, 2014