Diagnosis and early prognosis of acute ischemic stroke evolution: Summary of Ph.D. thesis in medical sciences: 312.02 - Neurosciences

Abstract

Stroke is the second leading cause of death in the 60+ age group, the fifth leading cause of death in the 15-59 age group, and the leading cause of permanent disability in adults in industrialized countries worldwide [1, 2, 3]. Acute ischemic stroke (AIS) accounts for about 85-90% of all strokes, about 10% are intracranial hemorrhages, and about 3% are strokes with subarachnoid hemorrhage. Posterior AIS represents 18-20% of all acute ischemic strokes [1, 2, 4, 5, 6]. Over 70% of stroke survivors and over 50% of stroke deaths are attributed to acute brain ischemia [6]. Thanks to the advantages (availability, speed and ability to present intracranial hemorrhage) that CT, compared to other imaging investigations, offers for the examination of stroke patients, a comprehensive three-component imaging protocol was developed – NCCT (non-contrast computed tomography), followed by ACT (angiography computed tomography) and PCT (perfusion computed tomography). Multimodal CT imaging in acute stroke can provide all the necessary information about the anatomy of the brain, the state of the cerebral vessels, the characteristics of the thrombus and the cerebral tissue hemodynamics before the administration of reperfusion treatment, thus avoiding an additional imaging study [3, 7]. Predicting long-term clinical outcomes in AIS is important, but it is not easy when we rely solely on patient symptoms, clinical signs, and NCCT. The results of recently published investigations on dynamic Perfusion CT exam found the feasibility and perspective of this method for rapid assessment of patients with AIS. PCT imaging, being a faster, accessible, more widely available diagnostic tool, relatively inexpensive and with proven benefits, offers practical advantages. PCT provides important parameters that significantly increase the accuracy of stroke diagnosis, regardless of the location (anterior or posterior circulation), predict disease outcome, present information on the blood–brain barrier (BBB) permeability and Hemorrhagic transformation (HT) riak, allow correct selection of patients for reperfusion treatment [7]. [...]