Open AccessOverestimation of core infarct by computed tomography perfusion in the golden hour
Author(s) -
Aldo A Mendez,
Darko QuispeOrozco,
Sudeepta Dandapat,
Edgar A Samaniego,
Emily Tamadonfar,
Cynthia Zevallos,
Mudassir Farooqui,
Colin P. Derdeyn
Publication year - 2020
Publication title -
brain circulation
Language(s) - English
Resource type - Journals
eISSN - 2455-4626
pISSN - 2394-8108
DOI - 10.4103/bc.bc_7_20
Subject(s) - medicine , perfusion , perfusion scanning , magnetic resonance imaging , cerebral blood flow , internal carotid artery , radiology , magnetic resonance angiography , angiography , middle cerebral artery , core (optical fiber) , computed tomography , ischemia , nuclear medicine , cardiology , materials science , composite material
A nonagenarian patient developed a right middle cerebral artery syndrome during recovery after a right internal carotid artery (ICA) balloon angioplasty. Emergent head computed tomography (CT) revealed no acute ischemic changes; CT angiography (CTA) and CT perfusion (CTP) demonstrated a right ICA occlusion with a large right hemispheric predicted core infarct by cerebral blood flow thresholds and minimal mismatch volume. She underwent complete reperfusion in <45 min from symptom onset. Magnetic resonance imaging brain obtained within 48 h showed a decreased infarct volume as that estimated by CTP. This case emphasizes the limitations of estimating the ischemic core with CTP in the golden hour with ultra-early reperfusion and suggests that CTP thresholds should not be used to exclude patients from treatment in the very early time window.