Value of Utilizing Both Aspects and CT Angiography Collateral Score for Outcome Prediction in Acute Ischemic Stroke

Background and Purpose: CT angiography yields rapid detection of a major cerebral vessel occlusion during the evaluation of patients with acute ischemic stroke leading to its widespread use in rapidly triaging for IA trial enrollment. In such trials, patients who have an extracranial carotid occlusion in tandem to the intracranial target lesion are typically excluded. However, ICA terminus occlusions may be misidentified as cervical carotid occlusions on CTA. The goal of this study is to determine the accuracy of CTA in identifying ICA terminus occlusions from tandem carotid occlusions (cervical and intracranial segments). Methods: Retrospective review of a prospectively maintained database containing patients treated at our comprehensive stroke center between 1996 and 2014 in whom catheter angiogram and CT angiogram were available on PACS. A Neuroradiologist, blinded to catheter angiographic results reviewed the CT angiography identifying the presence of intracranial stenoses and concomitant cervical carotid occlusions. Results: Of 196 patients presenting with intracranial carotid occlusions on catheter based angiogram, 101 patients were identified with good quality CT angiography and subsequent catheter angiograms. Mean ages for identified patients was 65 +/- 14, of which 52% women and 48% men. Forty-four percent of patients had an ASPECT score of 9-10. The overall rate of agreement between retrospective CTA and conventional angiography readings was 77%. Of 72 isolated intracranial occlusions on conventional angiography, CT angiography misidentified 23 cervical carotid occlusions. The sensitivity of CTA for detecting isolated carotid terminus occlusion was 68% in this cohort. Specific factors associated with CT and catheter based angiographic discrepancy are reviewed. Conclusions: The study raises systematic considerations for maximizing inclusion of patients with target arterial occlusions who are most likely to benefit from intra-arterial therapy in future clinical trials. Future steps will include determination of specificity, predictive value of CTA for localization of specific carotid occlusion sites. Clinical variables associated with lower CTA accuracy will also be examined.

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Intravenous flat-detector CT angiography in acute ischemic stroke management

Neuroradiology ◽

10.1007/s00234-011-0893-8 ◽

2011 ◽

Vol 54 (4) ◽

pp. 383-391 ◽

Cited By ~ 17

Author(s):

Raphaël Blanc ◽

Silvia Pistocchi ◽

Drazenko Babic ◽

Bruno Bartolini ◽

Michaël Obadia ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Ct Angiography ◽

Stroke Management ◽

Flat Detector

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Assessing the Relative Value of CT Perfusion Compared to Non-contrast CT and CT Angiography in Prognosticating Reperfusion-Eligible Acute Ischemic Stroke Patients

Frontiers in Neurology ◽

10.3389/fneur.2021.736768 ◽

2021 ◽

Vol 12 ◽

Author(s):

Andrew Bivard ◽

Christopher Levi ◽

Longting Lin ◽

Xin Cheng ◽

Richard Aviv ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Ct Angiography ◽

Predictive Accuracy ◽

Ct Perfusion ◽

Imaging Modality ◽

Characteristic Curve ◽

Treatment Decision ◽

Receiver Operator Characteristic Curve ◽

Stroke Patients

In the present study we sought to measure the relative statistical value of various multimodal CT protocols at identifying treatment responsiveness in patients being considered for thrombolysis. We used a prospectively collected cohort of acute ischemic stroke patients being assessed for IV-alteplase, who had CT-perfusion (CTP) and CT-angiography (CTA) before a treatment decision. Linear regression and receiver operator characteristic curve analysis were performed to measure the prognostic value of models incorporating each imaging modality. One thousand five hundred and sixty-two sub-4.5 h ischemic stroke patients were included in this study. A model including clinical variables, alteplase treatment, and NCCT ASPECTS was weak (R2 0.067, P < 0.001, AUC 0.605) at predicting 90 day mRS. A second model, including dynamic CTA variables (collateral grade, occlusion severity) showed better predictive accuracy for patient outcome (R2 0.381, P < 0.001, AUC 0.781). A third model incorporating CTP variables showed very high predictive accuracy (R2 0.488, P < 0.001, AUC 0.899). Combining all three imaging modalities variables also showed good predictive accuracy for outcome but did not improve on the CTP model (R2 0.439, P < 0.001, AUC 0.825). CT perfusion predicts patient outcomes from alteplase therapy more accurately than models incorporating NCCT and/or CT angiography. This data has implications for artificial intelligence or machine learning models.

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The features of carotid artery lesions evaluated by carotid ultrasonography and 3D-CT angiography in patients with acute ischemic stroke in Yamagata Prefecture, Japan

Nosotchu ◽

10.3995/jstroke.10431 ◽

2017 ◽

Vol 39 (2) ◽

pp. 113-118

Author(s):

Yasuaki Kokubo ◽

Rei Kondo ◽

Shinya Sato ◽

Yukihiko Sonoda ◽

Isao Kubota ◽

...

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Acute Ischemic Stroke ◽

Ct Angiography ◽

3D Ct ◽

Carotid Ultrasonography ◽

Carotid Artery Lesions ◽

3D Ct Angiography

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Alberta Stroke Program Early CT Score applied to CT angiography source images is a strong predictor of futile recanalization in acute ischemic stroke

Neuroradiology ◽

10.1007/s00234-016-1652-7 ◽

2016 ◽

Vol 58 (5) ◽

pp. 487-493 ◽

Cited By ~ 17

Author(s):

Michal M. Kawiorski ◽

Patricia Martínez-Sánchez ◽

Andrés García-Pastor ◽

Patricia Calleja ◽

Blanca Fuentes ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Ct Angiography ◽

Strong Predictor

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3D convolutional neural networks applied to CT angiography in the detection of acute ischemic stroke

European Radiology Experimental ◽

10.1186/s41747-019-0085-6 ◽

2019 ◽

Vol 3 (1) ◽

Cited By ~ 13

Author(s):

Olli Öman ◽

Teemu Mäkelä ◽

Eero Salli ◽

Sauli Savolainen ◽

Marko Kangasniemi

Keyword(s):

Neural Networks ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Ct Angiography ◽

Convolutional Neural Networks

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2 Imaging triage of late window patients with acute ischemic stroke. A comparative study using multi-phase CT angiography vs CT perfusion

10.1136/neurintsurg-2019-snis.225 ◽

2019 ◽

Author(s):

M Almekhlafi ◽

W Kunz ◽

R McTaggart ◽

M Jayaraman ◽

M Najm ◽

...

Keyword(s):

Ischemic Stroke ◽

Comparative Study ◽

Acute Ischemic Stroke ◽

Ct Angiography ◽

Ct Perfusion ◽

Multi Phase

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Comparison of four different collateral scores in acute ischemic stroke by CT angiography

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-012101 ◽

2015 ◽

Vol 8 (11) ◽

pp. 1116-1118 ◽

Cited By ~ 22

Author(s):

Fatih Seker ◽

Arne Potreck ◽

Markus Möhlenbruch ◽

Martin Bendszus ◽

Mirko Pham

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Ct Angiography ◽

Cross Correlation ◽

Single Phase ◽

Infarct Core ◽

Conventional Angiography ◽

Grading Systems ◽

American Society ◽

No Gold Standard

PurposeMultiple scores have been described for the assessment of collateralization in acute ischemic stroke. Currently, there is no gold standard for collateral assessment by CT angiography (CTA). This study compared four frequently used collateral scores with regard to their correlation with early infarct core and mismatch ratio.Methods30 consecutive patients with acute occlusion of the M1 segment or terminal carotid artery were reviewed retrospectively. Collaterals were assessed using dynamic and also single-phase CTA according to grading systems by the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR), Alberta Stroke Program Early CT Score (ASPECTS) (on collaterals), Christoforidis et al and Miteff et al. The Christoforidis and ASITN/SIR scores, which were initially designed for conventional angiography, were adapted to be applicable to CTA. The scores were compared with respect to early infarct core and mismatch ratio in perfusion CT estimated by RAPID software using Spearman correlation.ResultsASITN/SIR and ASPECTS collateral scores showed good correlation with early infarct core (rho=−0.696, p<0.001 and rho=−0.677, p<0.001) and mismatch ratio (rho=0.609, p<0.001 and rho=0.581, p<0.001). In contrast, the Christoforidis and Miteff scores correlated less well with infarct core (rho=0.245, p=0.191 and rho=−0.272, p=0.145, respectively) and mismatch ratio (rho=−0.329, p=0.075 and rho=0.279, p=0.135, respectively). ASPECTS and ASITN/SIR showed excellent cross-correlation (rho=0.901, p<0.001).ConclusionsCompared with the Christoforidis and Miteff scores, the modified ASITN/SIR and ASPECTS collateral scores showed consistently higher correlation with the extent of early infarct core and mismatch volume. This is probably because these scores evaluate the extent and delay of vascular enhancement in the affected territory rather than the backflow of contrast medium to the occlusion.

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