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Some patients with stroke after 6h can still be treated


A recent study by the American Stroke Society International Stroke Conference (ICS-2016) in 2016 showed that by performing CT perfusion scans on patients with ischemic stroke, intravascular intervention with typical stroke patients with neurological manifestations 6h time window limit. (Medscape website)

It has been suggested that the prognosis of patients who did not receive treatment within 6 hours after the onset of stroke was significantly worse. However, recent studies have confirmed that about 30% of patients have unique brain physiology, or imaging performance as "target mismatch" (defined as Tmax> 6 s lesion volume to core volume ratio> 1.8. Patients are more tolerant of stroke than others). In this case, the extended time window, the patient's response to intravascular treatment is good.Therefore, the identification of such patients is particularly important.

Previous DEFUSE 2 study confirmed that MRI perfusion scans can identify such patients. However, it may take 45 min ~ lh to perform an MRI scan, and the CT scan will be much faster - including routine CT-enhanced scans of the vast majority of stroke patients, plus an additional about 5 to 10 min.

The researchers analyzed the data of the CT Perfusion Scan for Predicting 2-Year Plan for Vascular Reperfusion Response (CRISP). The study included 102 patients over 18 years of age with ischemic stroke in six US medical centers. Baseline CT perfusion scan, confirmed that there is no matching area, and within 18 h of the symptoms of intravascular treatment.

The results showed that, overall, the median time to onset of symptomatic perfusion was 6.6 h. Symptoms of patients treated within 6 hours of treatment, 71.4% of the functional prognosis is good (md score at 0 d when the mRS score of 0 to 2 points), almost no disability; 6 ~ 18 h within the treatment of patients, the same 61.7% good prognosis.

Multivariate analysis showed that the onset time was not associated with a good prognosis, and the patient age (every 5 years), baseline NIHSS score, and Alberta stroke planning early diagnosis score were prognostic factors.

"Most of the available data show that treatment is beneficial to patients within 6 hours, and most stroke centers do not undergo perfusion imaging after 6 h of the time window, and the study shows that severe ischemic stroke after 6 h of symptom onset," the investigators noted. The patient should not stop the treatment, but through the CT perfusion scan, give the patient a chance to treat.

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