• Christopher D d'Esterre, Mari E Boesen, Seong Hwan Ahn, Pooneh Pordeli, Mohamed Najm, Priyanka Minhas, Paniz Davari, Enrico Fainardi, Marta Rubiera, Alexander V Khaw, Andrea Zini, Richard Frayne, Michael D Hill, Andrew M Demchuk, Tolulope T Sajobi, Nils D Forkert, Mayank Goyal, Ting Y Lee, and Bijoy K Menon.
• From the Calgary Stroke Program, Department of Clinical Neurosciences (C.D.d'E., S.H.A., P.P., M.N., P.M., P.D., M.D.H., A.M.D., T.T.S., M.G., B.K.M.), Department of Radiology (C.D.d'E., R.F., M.D.H., A.M.D., N.D.F., M.G., T.Y.L., B.K.M.), Department of Community Health Sciences (P.P., M.D.H., T.T.S., B.K.M.), and Biomedical Engineering Graduate Program (M.E.B., R.F.), University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada (R.F., M.D.H., A.M.D., N.D.F., M.G., B.K.M.); Seaman Family MR Research Centre, Foothills Medical Centre, Calgary, Alberta, Canada (C.D.d'E., M.E.B., S.H.A., M.N., R.F., M.D.H., A.M.D., M.G., B.K.M.); Department of Neurology, Chosun University School of Medicine, Gwang Ju, South Korea (S.H.A.); Department of Neurosciences and Rehabilitation, University Hospital, Ferrara, Italy (E.F.); Department of Neurology, Hospital Vall d'Hebron, Ps. Vall d'Hebron, Barcelona, Spain (M.R.); Lawson Health Research Institute and Robarts Research Institute, London, Ontario, Canada (T.Y.L.); Department of Clinical Neurosciences, University of Western Ontario, London, Ontario, Canada (A.V.K.); and Department of Neurosciences, University Hospital, Modena, Italy (A.Z.).
• Stroke. 2015 Dec 1; 46 (12): 3390-7.

Background And PurposeAmong patients with acute ischemic stroke, we determine computed tomographic perfusion (CTP) thresholds associated with follow-up infarction at different stroke onset-to-CTP and CTP-to-reperfusion times.MethodsAcute ischemic stroke patients with occlusion on computed tomographic angiography were acutely imaged with CTP. Noncontrast computed tomography and magnectic resonance diffusion-weighted imaging between 24 and 48 hours were used to delineate follow-up infarction. Reperfusion was assessed on conventional angiogram or 4-hour repeat computed tomographic angiography. Tmax, cerebral blood flow, and cerebral blood volume derived from delay-insensitive CTP postprocessing were analyzed using receiver-operator characteristic curves to derive optimal thresholds for combined patient data (pooled analysis) and individual patients (patient-level analysis) based on time from stroke onset-to-CTP and CTP-to-reperfusion. One-way ANOVA and locally weighted scatterplot smoothing regression was used to test whether the derived optimal CTP thresholds were different by time.ResultsOne hundred and thirty-two patients were included. Tmax thresholds of >16.2 and >15.8 s and absolute cerebral blood flow thresholds of <8.9 and <7.4 mL·min(-1)·100 g(-1) were associated with infarct if reperfused <90 min from CTP with onset <180 min. The discriminative ability of cerebral blood volume was modest. No statistically significant relationship was noted between stroke onset-to-CTP time and the optimal CTP thresholds for all parameters based on discrete or continuous time analysis (P>0.05). A statistically significant relationship existed between CTP-to-reperfusion time and the optimal thresholds for cerebral blood flow (P<0.001; r=0.59 and 0.77 for gray and white matter, respectively) and Tmax (P<0.001; r=-0.68 and -0.60 for gray and white matter, respectively) parameters.ConclusionsOptimal CTP thresholds associated with follow-up infarction depend on time from imaging to reperfusion.© 2015 American Heart Association, Inc.

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