Utility of Minimum Apparent Diffusion Coefficient Ratios in Alberta Stroke Program Early CT Score Regions for Deciding on Stroke Therapy.

BACKGROUND AND PURPOSE: Therapeutic indications for recombinant tissue plasminogen activator therapy and endovascular therapy need to be assessed for patients with hyperacute ischemic stroke. We investigated the relationship between the minimum apparent diffusion coefficient ratios in each Alberta Stroke Program Early CT Score region and reversible lesion in patients with hyperacute ischemic stroke receiving recombinant tissue plasminogen activator therapy and/or treated with endovascular therapy. MATERIALS AND METHODS: We retrospectively evaluated 29 patients with first ischemic stroke due to stenosis/occlusion of the internal carotid artery or horizontal portion of the middle cerebral artery that was successfully recanalized by recombinant tissue plasminogen activator therapy and/or treated with endovascular therapy. We measured the minimum apparent diffusion coefficient value in each Alberta Stroke Program Early CT Score region (11 regions) and calculated the ratio. RESULTS: There was a significant difference in minimum apparent diffusion coefficient ratios between regions that included and did not include infarction (P < .0001), which were distinguishable with a cutoff value of .808 (area under the curve = .80, P < .001). A statistical difference in the proportion of infarction with the cutoff value was observed between patients treated with endovascular therapy and receiving recombinant tissue plasminogen activator therapy alone (9.9% versus 24.6%, P = .0041) and between patients with affected middle cerebral and internal carotid arteries (7.0% versus 24.2%, P = .0002). The lowest apparent diffusion coefficient ratio was associated with the time to recombinant tissue plasminogen activator injection. CONCLUSIONS: Minimum apparent diffusion coefficient ratios in Alberta Stroke Program Early CT Score regions are useful in predicting therapeutic effect.

Evaluation of clinical significance of decompressive suboccipital craniectomy on the prognosis of cerebellar infarction.

OBJECTIVE: The decision of whether and/or when to treat cerebellar infarction surgically remains controversial. We investigated the effectiveness of decompressive suboccipital craniectomy (DSC) for treating cerebellar infarction and the prognostic factors that affect the surgical results. METHODS: From October 2006 to June 2017, a total of 14 consecutive patients (12 men, 2 women; mean±SD age 65±12 years, range 42-84 years) were admitted to our hospital and underwent DSC at the time of admission or during their hospitalization. Inclusion criteria were (1) a level of consciousness below Glasgow Coma Scale (GCS) 13, and/or (2) brainstem compression and/or obstructive hydrocephalus caused by brain edema due to cerebellar infarction. Ventricular drainage was performed simultaneously or later, according to the surgeon's decision. RESULTS: At the 90-day point, 12 of the 14 patients (85.7%) had survived, 10 (71.4%) of whom were independent (modified Rankin scale ≤2). Four (28.6%) were either completely dependent or dead. Comparisons between good and poor prognoses showed that the factors affecting the prognosis were lesions other than the cerebellar infarction (p<0.01) and/or obstructive hydrocephalus (p<0.05). CONCLUSIONS: Early DSC should be considered for treating cerebellar infarction in patients with GCS 13 or worse. A poor prognosis is inevitable in patients whose infarction is combined with other location than the cerebellum but in those who already have obstructive hydrocephalus at the time of surgery.