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Ospel JM, Rex N, Rinkel L, Kashani N, Buck B, Rempel J, Sahlas D, Kelly ME, Budzik R, Tymianski M, Hill MD, Goyal M. Prevalence of "Ghost Infarct Core" after Endovascular Thrombectomy. AJNR Am J Neuroradiol 2024; 45:291-295. [PMID: 38272571 DOI: 10.3174/ajnr.a8113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 12/01/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND AND PURPOSE Baseline CTP sometimes overestimates the size of the infarct core ("ghost core" phenomenon). We investigated how often CTP overestimates infarct core compared with 24-hour imaging, and aimed to characterize the patient subgroup in whom a ghost core is most likely to occur. MATERIALS AND METHODS Data are from the randomized controlled ESCAPE-NA1 trial, in which patients with acute ischemic stroke undergoing endovascular treatment were randomized to intravenous nerinetide or placebo. Patients with available baseline CTP and 24-hour follow-up imaging were included in the analysis. Ghost infarct core was defined as CTP core volume minus 24-hour infarct volume > 10 mL). Clinical characteristics of patients with versus without ghost core were compared. Associations of ghost core and clinical characteristics were assessed by using multivariable logistic regression. RESULTS A total of 421 of 1105 patients (38.1%) were included in the analysis. Forty-seven (11.2%) had a ghost core > 10 mL, with a median ghost infarct volume of 13.4 mL (interquartile range 7.6-26.8). Young patient age, complete recanalization, short last known well to CT times, and possibly male sex were associated with ghost infarct core. CONCLUSIONS CTP ghost core occurred in ∼1 of 10 patients, indicating that CTP frequently overestimates the infarct core size at baseline, particularly in young patients with complete recanalization and short ischemia duration.
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Affiliation(s)
- Johanna M Ospel
- From the Department of Diagnostic Imaging (J.M.O., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences (J.M.O., N.R., L.R., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada
| | - Nathaniel Rex
- Department of Clinical Neurosciences (J.M.O., N.R., L.R., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada
- Department of Diagnostic Imaging (N.R.), Brown University, Providence, Rhode Island
| | - Leon Rinkel
- Department of Clinical Neurosciences (J.M.O., N.R., L.R., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada
- Department of Neurology (L.R.), Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Nima Kashani
- Department of Neurosurgery (N.K., M.E.K.), University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Brian Buck
- University of Alberta Hospital (B.B., J.R.), Edmonton, Alberta, Canada
| | - Jeremy Rempel
- University of Alberta Hospital (B.B., J.R.), Edmonton, Alberta, Canada
| | | | - Michael E Kelly
- Department of Neurosurgery (N.K., M.E.K.), University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ron Budzik
- Ohio Health (R.B.), Riverside Methodist Hospital, Columbus, Ohio
| | | | - Michael D Hill
- From the Department of Diagnostic Imaging (J.M.O., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences (J.M.O., N.R., L.R., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada
| | - Mayank Goyal
- From the Department of Diagnostic Imaging (J.M.O., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences (J.M.O., N.R., L.R., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada
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Fiehler J, Nawka MT, Meyer L. Persistent challenges in endovascular treatment decision-making for acute ischaemic stroke. Curr Opin Neurol 2022; 35:18-23. [PMID: 34812746 DOI: 10.1097/wco.0000000000001006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Although endovascular treatment (EVT) is the gold standard for treating acute stroke patients with large vessel occlusion (LVO), multiple challenges in decision-making for specific conditions persist. Recent evidence on a selection of patient subgroups will be discussed in this narrative review. RECENT FINDINGS Two randomized controlled trials (RCTs) have been published in EVT of basilar artery occlusion (BAO). Large single arm studies showed promising results in Patients with low Alberta stroke program early CT score (ASPECTS) and more distal vessel occlusions. Recent data confirm patients with low National Institutes of Health Stroke Scale (NIHSS) despite LVO to represent a heterogeneous and challenging patient group. SUMMARY The current evidence does not justify withholding EVT from BAO patients as none of the RCTs showed any signal of superiority of BMT alone vs. EVT. Patients with low ASPECTS, more distal vessel occlusions and patients with low NIHSS scores should be included into RCTs if possible. Without participation in a RCT, patients should be selected for EVT based on age, severity and type of neurological impairment, time since symptom onset, location of the ischaemic lesion and perhaps also results of advanced imaging.
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Affiliation(s)
- Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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