Overestimation of core infarct by computed tomography perfusion in the golden hour

• Main Authors: Aldo A Mendez, Darko Quispe-Orozco, Sudeepta Dandapat, Edgar A Samaniego, Emily Tamadonfar, Cynthia B Zevallos, Mudassir Farooqui, Colin P Derdeyn, Santiago Ortega-Gutierrez
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2020-01-01
• Series: Brain Circulation
• Subjects: acute ischemic stroke; cerebral blood flow; computed tomography perfusion; endovascular treatment; ghost core infarct
• Online Access: http://www.braincirculation.org/article.asp?issn=2394-8108;year=2020;volume=6;issue=3;spage=211;epage=214;aulast=Mendez
• ISSN: 2455-4626

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.