Assessment of CT Perfusion in Acute Ischemic Stroke Among Patients Attending at a Tertiary Care Hospital of Chitwan, Nepal

Abstract

Background
Acute ischemic stroke (AIS) is one of the leading causes of mortality and long-term disability worldwide. Early identification of salvageable brain tissue is essential for timely intervention and improved outcomes. CT perfusion (CTP) imaging has emerged as an important diagnostic tool that evaluates cerebral hemodynamic using parameters such as cerebral blood flow, cerebral blood volume, mean transit time, and time-to-maximum. This study aimed to evaluate the role of CT perfusion in AIS among patients attending a tertiary care hospital in Bharatpur, Chitwan, Nepal.
Methods
An analytical cross sectional study was conducted among 50 patients diagnosed with AIS over the period of 2 years. Patients aged ≥18 years presenting within 24 hours of symptom onset and undergoing CT perfusion imaging were included. Demographic as well as clinical information were collected. Functional outcome was assessed using the modified Rankin Scale (mRS) at 90 days. Data was analysed using descriptive and inferential statistical tools in SPSS. P-value<0.05 was considered as statistically significant.
Results
In the present study, 56% of patients had a favourable outcome. Favourable outcomes were associated with smaller ischemic core volumes (18.5 ± 7.3 vs 49.3 ± 10.6 mL, p < 0.01), higher penumbra-to-core ratios (4.2 ± 1.1 vs 1.9 ± 0.8, p < 0.05), larger mismatch volumes (76.8 ± 12.5 vs 33.5 ± 10.2 mL, p < 0.05), lower Tmax >6 s volumes (65.2 ± 14.8 vs 98.6 ± 20.1 mL, p < 0.01), younger age, lower baseline NIHSS, and shorter onset-to-treatment time. Infarct core volume was strongly associated with 90-day outcome (p = 0.001).
Conclusions
CT perfusion imaging plays an important role in the evaluation and management of acute ischemic stroke by identifying salvageable brain tissue and predicting functional outcomes. Integration of CT perfusion into routine stroke assessment can improve patient selection for reperfusion therapy and enhance clinical outcomes.