Randomised, controlled Trial of CT perfusion and angiography compared to CT alone in thrombolysis-eligible acute ischaemic stroke patients: The penumbra and recanalisation acute computed tomography in ischaemic stroke evaluation (PRACTISE) trial.

IF 4.5 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2025-09-19 DOI:10.1177/23969873251372348

Keith W Muir, Salwa El Tawil, Alex McConnachie, Ian Ford, Grant Mair, Jattinder Khaira, Kausik Chatterjee, Laszlo Sztriha, Omid Halse, Ibrahim Balogun, Sanjeev Nayak, Phil White, Elizabeth A Warburton, Joanna Wardlaw

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引用次数: 0

Abstract

Introduction: The role of CT angiography (CTA) and CT perfusion (CTP) in patient selection for thrombolysis <4.5 h after onset is unclear. Additional imaging may improve specificity of diagnosis by excluding stroke mimics or those without salvageable tissue, but may delay treatment.

Patients and methods: In a multicentre prospective randomised trial, thrombolysis-eligible patients <4.5 h from symptom onset were randomised 1:1 to non-contrast CT (NCCT) or multimodal CT (NCCT + CTA + CTP). The primary endpoint was the proportion receiving thrombolysis. Secondary end-points were times to decision-making and treatment delivery, early neurological recovery, functional recovery at 3 months and incidence of symptomatic intracerebral haemorrhage (SICH).

Results: Between March 2015 and May 2018, 271 patients were randomised, 134 to multimodal CT and 137 to NCCT. After initial NCCT, 114 had no contraindication to thrombolysis in the multimodal CT group and 108 in the NCCT group. Mean age was 67.5 years and median NIHSS score was 6 (interquartile range 3-12). Fewer patients assigned multimodal CT received thrombolysis (56/114, 49.1%) compared to NCCT (73/108, 67.6%, adjusted odds ratio (aOR) 0.46 (95% CI: 0.25-0.83), p = 0.0102). Times to treatment decision or thrombolytic administration, early neurological recovery and day 90 functional outcome did not differ significantly. SICH occurred in two patients, both assigned NCCT. Mortality was 6/114 (5.3%) in the multimodal CT group compared to 11/108 (10.2%; aOR 0.46 (95% CI: 0.16, 1.31), p = 0.147) in the NCCT group.

Discussion: Despite fewer patients receiving thrombolysis after multimodal imaging, treatment decision times and clinical outcomes did not differ significantly. Multimodal CT may identify patients who do not require thrombolysis such as stroke mimics and non-disabling strokes.

Conclusion: Among acute stroke patients imaged <4.5 h from symptom onset, multimodal CT reduced use of thrombolysis. Treatment decision times and clinical outcomes did not differ between groups.

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在符合溶栓条件的急性缺血性卒中患者中，CT灌注和血管造影与单独CT比较的随机对照试验：半暗区和再通急性计算机断层扫描在缺血性卒中评估中的应用（实践）试验。

CT血管造影（CTA）和CT灌注（CTP）在溶栓患者和方法选择中的作用：在一项多中心前瞻性随机试验中，溶栓符合条件的患者。结果：2015年3月至2018年5月，271例患者被随机分组，134例接受多模态CT治疗，137例接受NCCT治疗。初始NCCT后，多模式CT组114例无溶栓禁忌症，NCCT组108例无溶栓禁忌症。平均年龄67.5岁，NIHSS评分中位数为6分（四分位数范围3-12）。与NCCT（73/108, 67.6%，校正优势比（aOR） 0.46 (95% CI: 0.25-0.83), p = 0.0102）相比，多模态CT组接受溶栓治疗的患者较少（56/114,49.1%）。决定治疗或溶栓治疗的时间、早期神经恢复和第90天的功能结果没有显著差异。2例患者发生SICH，均为NCCT。多模态CT组的死亡率为6/114(5.3%)，而NCCT组的死亡率为11/108 （10.2%；aOR为0.46 (95% CI: 0.16, 1.31), p = 0.147）。讨论：尽管在多模态成像后接受溶栓治疗的患者较少，但治疗决策时间和临床结果没有显著差异。多模态CT可以识别不需要溶栓的患者，如卒中模拟和非致残性卒中。结论：在急性脑卒中患者中

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.