There were 103 patients,
64 males (62%) and 39 females (38%); mean age was 68 years,
median age was 72 years (min 20,
max 89).
Ninety patients (88%) had a mRS of 0 or 1 prior to stroke.
Median NIHSS was 10 (range 1–25).
Mean ASPECTS score was 8,
median 9 (range 1 to 10).
At CTP 48 patients had a large mismatch (47%) (Fig.1), 21 patients had a small mismatch (20%) (fig.2),
4 patients had no mismatch,
showing all core lesion (4%); CTP was negative in 30 patients (29%).
There were 19 strokes with unknown hour of onset,
13 of those being WUS.
First opinion decisions were: to treat 45 patients (44%),
not to treat 28 patients (27%),
and to delay the decision in 30 patients (29%).
Then,
after getting the CTP results (second opinion) a final clinical decision was made for 20 more patients.
Overall,
i.v.
rtPA treatment was administered in 53 patients (51%) while no treatment was decided for 40 patients (39%).
In 10 patients (10%), there was still doubt for treatment,
related to high blood pressure and high fasting glucose.
These results are summarized in the Table 3.
It is interesting to note that,
while in no patient of the treatment group the decision was changed by CTP data (no changes from yes to no,
or from yes to doubt),
CTP encouraged our expert to decide for treating in an extra 7 patients and even to switch a patient from the no-treatment to the treatment group (Fig.
3).
Another patient,
previously included in the no-treatment group,
was now "upgraded" to the "in doubt" arm.
In 14 patients "in doubt" the decision was not to treat.
Thus,
CTP data significantly reduced the uncertainty (turning from doubt to yes or no treatment) in 19.4% of all our patients.
We then evaluated in which cases CTP data was found useful for decision-making.
In particular,
we aimed to identify patients’ characteristics associated with clearing a doubtful case to be treated with more confidence by our expert neurologist.
CTP results were significantly more useful in clarify doubtful cases in milder strokes.
Of note is the fact that in his second opinion,
our expert was still in doubt mainly because of non-radiological reasons (i.e.,high blood pressure values on admission or hyperglycemia),
later resolved.