Acute Stroke Clinical Trial
Official title:
The Dutch Acute Stroke Trial (DUST): Prediction of Outcome With CT-perfusion and CT-angiography
Less than 10% of all ischemic stroke patients are treated by intravenous thrombolysis (IVT)
as most present later than the accepted 3 hour time window. Intra-arterial thrombolysis
(IAT) is possible 3-6 hours post ictus, but is infrequently used. Mechanical thrombectomy
(MT) with a MERCI device is a new intervention possibility but lacks large randomized
studies. Although it is desirable to treat more stroke patients, clinical information and
plain CT alone are insufficient to discriminate which patients are most likely to benefit or
be harmed from treatment. Advanced imaging techniques can help predict patient outcome and
provide the necessary information to weigh expected benefit against associated risk of
treatment. Visualizing the penumbra, the hypoperfused tissue at risk of infarction around
the irreversible infarct core, is one way of identifying patients most likely to benefit
from intervention. Magnetic resonance imaging (MRI) based selection of patients with
sufficient penumbra for thrombolysis is possible, however, MR has less 24-hour availability
than CT in the acute setting. Plain CT is mostly used to exclude intracerebral hemorrhage,
and can easily be extended with CT perfusion (CTP) and CT angiography (CTA). CTP compares
well to MRI for imaging penumbra and infarct core, and it is faster and more feasible than
MRI. Other image findings such as infarct core size and leakage of the blood-brain-barrier
(permeability) on CTP, and site and extent of the occlusion and collateral circulation on
CTA also influence stroke outcome but have not been combined in one study to assess their
combined predictive value.
Hypothesis:
The investigators hypothesize that combined CTP and CTA parameters can predict patient
outcome in acute ischemic stroke.
n/a
Observational Model: Cohort, Time Perspective: Prospective
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