Abstract Number: LBA18 Tissue‐Based Perfusion Imaging in Acute Cerebral Small Vessel Disease Ischemic Stroke

Abstract

Introduction There is growing evidence for the role of CT perfusion in tissue‐based treatment of acute ischemic stroke (AIS) secondary to large vessel occlusion (LVO). The utility of tissue‐based perfusion imaging in acute cerebral small vessel disease AIS may be low yield with current technology available. The purpose of this study was to evaluate the utility of CT perfusion in identifying small lenticulostriate hypoperfusion in cerebral small vessel disease strokes. Methods Get With The Guidelines database was used for retrospective chart review of patients presenting to our comprehensive stroke center with small vessel disease stroke defined as subcortical or brain stem lacunar infarction < 1.5 cm. Other stroke etiologies were excluded. A tissue‐based grading system was used to identify regions of hypoperfusion ordinally ranging from 0 to 5 (1‐thalamocapsular, 1‐basal ganglia, 2‐internal capsule, 1 caudate). Two board‐certified vascular neurologists independently evaluated CT perfusion maps, and Cohen’s K was used to determine kappa inter‐rater agreement. Lesions were later confirmed with MR diffusion‐weighted imaging. Social science statistics software was used for data analysis. Results From April 2017 to July 2022, out of 563 patients with small vessel disease stroke, 77 patients had CT perfusion. Thirty‐nine subjects were excluded because they did not meet inclusion criteria. Mean age was 67.09 (95% CI 62.82, 71.37), and 10 subjects (31.25%) were female. and presenting NIHSS was 5.28 (95% CI 3.97, 6.58). Baseline characteristics including history of coronary artery disease, atrial fibrillation, diabetes mellitus including hemoglobin A1C, hypertension, hyperlipidemia including LDL, stroke, intracranial hemorrhage, tobacco use, anti‐thrombotic use, presenting systolic blood pressure, presenting blood glucose, last known normal were assessed. Three subjects received IV thrombolytics. All subjects (n = 32) had normal CT perfusion maps (kappa = 1). Conclusions Mismatch was not identified on CT perfusion in all subjects with small vessel disease stroke using conventional CT perfusion map protocols, that could have been useful in potentially guiding therapeutic optimization of hemodynamics. Larger, prospective studies are needed to validate our results.