Aim: To investigate the outcomes of acute ischemic stroke patients defined as incomplete reperfusion using flat panel detector Computer Tomography perfusion (CTP) imaging immediately after thrombectomy.
Methods: We analyzed thrombectomy patients who underwent pre-treatment CTP and flat panel detector CTP (fpCTP) immediately after thrombectomy in the angiography suite. Compete reperfusion is defined as no perfusion deficit (Delay Time (DT) >3s lesion) on the flat panel detector CTP. Incomplete reperfusion is defined as residual perfusion deficit (DT >3s lesion) on fpCTP. The association between incomplete reperfusion and functional independence at 3-month (modified Rankin Score 0-2) in patients who achieved complete angiographic reperfusion (eTICI 3) was assessed.
Results: Of the 106 patients analyzed, 48 (45%) patients achieved eTICI 3 after thrombectomy. Seventeen (35%) of the 48 had incomplete reperfusion on fpCTP, and 24 (41%) of the patients with eTICI 0-2c had incomplete reperfusion on the fpCTP (p=0.530). Within the eTICI 3 patients, those with incomplete reperfusion on fpCTP had a lower rate of functional independence at 3-months compared to those who achieved complete reperfusion (23% vs. 59%, P=0.032). Incomplete reperfusion on fpCTP was also associated with a higher hemorrhagic transformation (HT, any type) rate than patients who achieved complete reperfusion (40% vs. 14%, P=0.049.)
Conclusion: Incomplete reperfusion shown on the flat panel CTP is associated with poor clinical outcomes and a higher rate of HT despite apparently ‘successful’ angiographic reperfusion after thrombectomy. This paves the way for ‘on-table’ Angio perfusion to guide rescue therapy such as intra-arterial thrombolytic.