CT perfusion (CTP) of the brain is an innovative technique to identify rapidly regions which are only partially or insufficiently perfused during an acute ischemic event. The differentiation between the core infarct and the still viable penumbra is its major clinical application. CTP helps directly in the decision-making process in the event of acute ischemic stroke by increasing the potential of success in patient who can benefit from thrombolytic/endovascular treatment.
The use of CTP in patient selection for thrombolytic/endovascular treatment was never evaluated in a prospective randomized study. Yet, clinical experience well demonstrated a good correlation between the size of the penumbra and the clinical outcome when done in early as well as late stages of the event.
The importance of identifying the penumbra in the acute phase of the ischemic stroke is widely accepted. But crucial evidence to support the predictive value of CTP to predict the clinical and anatomical/structural outcomes in the late phases (90 days after) is lacking.
Currently, the use of CTP is based on theoretical assumptions and expert opinions but a randomized prospective study to validate its use is lacking.
The current guidelines restrict the use of CTP trials and to patients that can't performed MRI scan.
- Alteplase Drug
Intervention Desc: subject in this group will receive intravenous tPA ARM 1: Kind: Experimental Label: IV tPA Description: patient will receive intravenous thrombolysis treatment
- Acetylsalicylic acid, clopidogrel bisulfate and/or warfarin, Apixaban, Rivaroxaban, Dabigatran Drug
Other Names: Aspirin, Plavix, Coumadin, Eliquis,Xarelto, Pradaxa, Sintrom Intervention Desc: subject in this group will receive oral treatment with anti platelet drug ARM 1: Kind: Experimental Label: Conservative Description: patient will get treatment with Antiplatelets or Anticoagulant depending on their clinical status/etiology
- Endovascular Procedure
Other Names: subject in this group will undergo mechanical thrombectomy ARM 1: Kind: Experimental Label: Endovascular treatment Description: patient who will receive endovascular treatment
- Observation: Cohort
- Perspective: Prospective
- Sampling: Non-Probability Sample
men and women admittedto the emergency room at Rabin Medical Center, Beilinson Campus and hospitalized at the neurology department.
|Type||Measure||Time Frame||Safety Issue|
|Primary||The predictive value of CTP in identifying penumbra (salvagable brain tissue) in event of ischemic stroke||three month||No|
- Rabin Medical Center Lead