Abstract W MP20: Automation and Quantification of the Angiographic Capillary Blush in Patients with Acute Ischemic Stroke undergoing Endovascular Intervention

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jason Tarpley ◽  
Fabien Scalzo ◽  
Jeffry R Alger ◽  
Amin Aghaebrahim ◽  
Conrad Liang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cerebral Blood Volume ◽  
Spatial Information ◽  
Endovascular Intervention ◽  
Ordinal Scale ◽  
Conventional Angiography ◽  
Non Invasive ◽  
Angiography Suite ◽  
Scale Properties

Background: In acute ischemic stroke, non-invasive perfusion imaging can guide the decision to perform endovascular intervention. A subset of these patients who are ineligible for IV TPA or for whom it has failed may benefit by going directly to endovascular intervention without delays imposed by non-invasive imaging. In these patients, an angiographic biomarker of viable brain tissue such as the capillary blush described by the Capillary Index Score (CIS) will be important for decision making in the angiography suite. Indeed, a favorable CIS score is associated with good outcomes when recanalization is achieved. However, any ordinal angiographic scale is observer dependent and limited by scale properties. Methods: Here we used our novel perfusion angiography software (PerfAngio) to extract cerebral blood volume (CBV) maps from conventional angiograms acquired during endovascular intervention at either UPMC or UCLA. Areas of angiographic blush were selected manually from a subset of the angiograms. These blush areas trained a machine learning model to identify features of angiographic blush from CBV maps to produce blush maps. Results: In the figure, we show PerfAngio’s blush map in a patient with acute proximal MCA occlusion prior to endovascular recanalization. At each pixel cool colors represent low likelihood of capillary blush and hotter colors represent higher likelihood of blush. These color maps allow for spatial characterization of the blush and quantifies it as a continuous variable rather than according to an ordinal scale. Conclusions: PerfAngio blush maps allow for automation and quantification of the blush seen during conventional angiography. These maps render data that does not depend on observer interpretation and provide spatial information about the capillary blush that is not captured by the CIS. Since PerfAngio blush maps can be acquired in real time, they are amenable for use in the angiography suite to inform the decision to recanalize or not.

Abstract WP57: Utility of Flat Panel CT Perfusion for Physiologic Assessment of Acute Ischemic Stroke in the Angiography Suite

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Robert W Ryan ◽  
Paula Eboli ◽  
Michael J Alexander ◽  
Shlee S Song ◽  
Marcel M Maya ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Perfusion Defect ◽  
Ct Perfusion ◽  
Endovascular Intervention ◽  
Flat Panel ◽  
Post Intervention ◽  
Angiography Suite ◽  
Before And After

Introduction The decision to perform endovascular intervention in patients with acute ischemic stroke (AIS) may be guided by physiologic imaging such as CT perfusion (CTP) demonstrating a salvageable penumbra, but such studies can delay transfer to the angiography suite. Flat Panel Detector CT (FPD-CT) allows pre, intra and post-procedural physiologic assessment using rotational images acquired on the angiography table; however these measurements have not been correlated with conventional perfusion techniques. We began a prospective, observational comparison of standard, multi-slice CTP with FPD-CT perfusion for AIS interventions, and report our initial results. Methods Patients with AIS that are candidates for endovascular intervention and have standard CTP images available were enrolled in the study after obtaining informed consent and following the IRB approved protocol. FPD-CTP images were obtained with aortic contrast injection and commercially available workstation image assessment (Siemens, Erlangen, Germany) before and after intervention, and compared with standard CT perfusion and follow up images. Results A total of 3 cases have been enrolled. All demonstrated anatomic correlations between perfusion defects in the standard CTP and the FPD-CTP. Case example: A 58 year old man developed left sided hemiplegia and standard CTP demonstrated a right MCA defect with a small core infarction (Fig 1 A). Pre-intervention FPD-CTP showed the same defect pattern (Fig 1 B), and successful mechanical thrombectomy was performed (Fig 1 C,D). Post-intervention FPD-CT showed reversal of perfusion defect outside the core infarct (Fig 1 E). The patient had good clinical recovery and only small infarct on follow up CT (Fig 1 F). Conclusions Early experience with FPD-CTP imaging shows correlation with standard CTP images and reversal of perfusion defect following successful recanalization, suggesting it may be a valuable aid for decision making in AIS intervention.

Abstract 2825: History of Cancer Predicts Mortality After Acute Endovascular Treatment for Ischemic Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Karl Meisel ◽  
Mahesh Jayaraman ◽  
Jonathan Grossberg ◽  
Anthony Kim
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Hospice Care ◽  
Exploratory Analysis ◽  
Endovascular Intervention ◽  
Consecutive Series ◽  
History Of ◽  
History Of Cancer

Introduction: Endovascular treatment is an emerging therapy for acute ischemic stroke. There is no clear consensus about how best to select patients that may benefit from intervention. We conducted an exploratory analysis of clinical risk factors to predict mortality after endovascular intervention in order to better understand how to improve outcomes for patients with acute ischemic stroke. Methods: We identified consecutive series of patients treated with endovascular therapy for acute ischemic stroke at two academic hospitals between 2005 to 2010. Key clinical data elements and clinical outcomes at the time of discharge were abstracted from medical records. We evaluated univariate and multivariable associations using logistic regression and compared mean NIH Stroke Scale between those with and without a history of cancer using the t-test. Results: We identified 88 patients who received endovascular intervention with intra-arterial tissue plasminogen activator (t-PA) and/or mechanical thrombectomy. The mean age of the cohort was 68.2 (SD 16.6) and 44 (55%) were female. A total of 23 (26.1%) patients died during the index hospitalization or were discharged to hospice care. A history of cancer was documented in 20 (22.7%) patients. A history of cancer was associated with a 3.2-fold (95% CI 1.1-9.1) higher odds of mortality. This association persisted after adjusting for age greater than 80 years and hypertension (OR of 4.0, 95% CI 1.3-12). The average NIH Stroke Scale was 15.6 in those with cancer compared to 14.6 without (p=0.53). A history of cancer was not associated with parenchymal hemorrhagic transformation (OR 1.2, 95% CI 0.3-4.9), IV tPA (OR 0.5, 95% CI 0.1-2.3), a TIMI score of 2b or 3 (OR 0.5, 95% CI 0.2-1.3), or an internal carotid artery occlusion (OR 1.7, 95% CI 0.5-5.1). Conclusions: In an exploratory analysis of consecutive patients with acute ischemic stroke treated with endovascular therapy, a history of cancer was strongly associated with significantly increased odds of mortality. One possible explanation could be that patients with cancer may have earlier withdrawal of care but the reasons for this observed association are unclear. Further investigation is necessary to verify and explain the reasons for this observation in order to improve outcomes for acute ischemic stroke patients.

Non-contrast head CT alone for thrombectomy in acute ischemic stroke: analysis of the ANGEL-ACT registry

2021 ◽  
pp. neurintsurg-2021-017940
Author(s):  
Zeguang Ren ◽  
Gaoting Ma ◽  
Maxim Mokin ◽  
Ashutosh P Jadhav ◽  
Baixue Jia ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Primary Outcome ◽  
Ct Perfusion ◽  
Non Invasive ◽  
Vessel Imaging ◽  
Baseline Characteristics ◽  
Procedural Outcomes ◽  
Head Computed Tomography

BackgroudThe goal of this study was to determine if the choice of imaging paradigm performed in the emergency department influences the procedural or clinical outcomes after mechanical thrombectomy (MT).MethodsThis is a retrospective comparative outcome study which was conducted from the ANGEL-ACT registry. Comparisons were made between baseline characteristics and clinical outcomes of patients with acute ischemic stroke undergoing MT with non-contrast head computed tomography (NCHCT) alone versus patients undergoing NCHCT plus non-invasive vessel imaging (NVI) (including CT angiography (with or without CT perfusion) and magnetic resonance angiography). The primary outcome was the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes included change in mRS score from baseline to 90 days, the proportions of mRS 0–1, 0–2, and 0–3, and dramatic clinical improvement at 24 hours. The safety outcomes were any intracranial hemorrhage (ICH), symptomatic ICH, and mortality within 90 days.ResultsA total of 894 patients met the inclusion criteria; 476 (53%) underwent NCHCT alone and 418 (47%) underwent NCHCT + NVI. In the NCHCT alone group, the door-to-reperfusion time was shorter by 47 min compared with the NCHCT + NVI group (219 vs 266 min, P<0.001). Patients in the NCHCT alone group showed a smaller increase in baseline mRS score at 90 days (median 3 vs 2 points; P=0.004) after adjustment. There were no significant differences between groups in the remaining clinical outcomes.ConclusionsIn patients selected for MT using NCHCT alone versus NCHCT + NVI, there were improved procedural outcomes and smaller increases in baseline mRS scores at 90 days.

Abstract W P32: Association of Low Cerebral Blood Volume With Negative FLAIR Hyperintensity in Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Nandakumar Nagaraja ◽  
Marie Luby ◽  
Matthew Edwardson ◽  
Ramin Zand ◽  
Lawrence L Latour
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Blood Volume ◽  
Early Phase ◽  
Cerebral Blood Volume ◽  
Time Window ◽  
Linear Regression Analysis ◽  
Onset Time ◽  
Stroke Onset ◽  
Imaging Biomarker

Objective: FLAIR hyperintensity is being used in clinical trials as a surrogate imaging biomarker for stroke onset time to test the safety of thrombolysis. Studies have shown that patients with negative and positive FLAIR hyperintensity overlap at similar time points from stroke onset in the early phase of acute ischemic stroke (AIS). Hyperintensity on FLAIR MRI likely represents increased tissue water content. We sought to determine if cerebral blood volume (CBV) mediates FLAIR hyperintensity in the early phase of AIS. Methods: AIS patients seen in 2012 were included in the study if i) onset time was known, ii) an MRI with perfusion was performed within 12 hours of onset time, iii) had imaging confirmed vascular occlusion of ICA, M1, or M2. Following co-registration of raw perfusion images with FLAIR, CBV maps were generated using PMA ASIST™ software. Two raters blinded to clinical information separately evaluated the DWI, FLAIR and CBV maps and measured the signal intensity ratio (SIR) for the brightest region on FLAIR normalized by homologous contra-lateral tissue. The SIR was similarly measured for CBV in same region. FLAIR negative was defined as SIR<1.15, “Low CBV” was defined as CBV SIR <0.5. Results: One hundred eighty two patients were screened and 30 met all study criteria; 21 women, with mean age of 71 (± 16) years and median NIHSS 18 (IQR 9-22). Using linear regression analysis, CBV SIR was associated with FLAIR SIR (p <0.049). In the 0-3hr time window, overall CBV was not associated with FLAIR hyperintensity. However, in the 3-7.5hr time window, patients with negative FLAIR were more likely to have low CBV and conversely, patients with positive FLAIR were more likely to have normal CBV. Conclusion: CBV likely mediates FLAIR hyperintensity in 3-7.5hr of stroke onset but it has less impact on FLAIR hyperintensity in the first 3 hours of AIS. Low CBV could be a potential surrogate imaging biomarker in addition to FLAIR hyperintensity in the early phase of AIS.

Abstract W P37: Accuracy Of CT Angiography In The Localization Of Carotid Occlusion Sites In Acute Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Marcelo Rocha ◽  
William T Delfyett ◽  
Amin Aghaebrahim ◽  
Ashutosh Jadhav ◽  
Tudor Jovin
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Ct Angiography ◽  
Target Lesion ◽  
Carotid Occlusion ◽  
Conventional Angiography ◽  
Vessel Occlusion ◽  
Cerebral Vessel ◽  
Ct Angiogram ◽  
Comprehensive Stroke Center

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.

Abstract P348: Perfusion Collateral Index vs. Hypoperfusion Intensity Ratio in Assessment of Angiographic Collateral Scores in Patients With Acute Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Brian Tsui ◽  
Iris Chen ◽  
Joe Qiao ◽  
Kasra Khatibi ◽  
Lucido Ponce Mejia ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Perfusion Imaging ◽  
Intensity Ratio ◽  
Roc Analysis ◽  
Cerebral Blood Volume ◽  
Imaging Biomarker ◽  
Lesion Volume ◽  
Significant Difference ◽  
Sensitivity Specificity

Background and Purpose: In acute ischemic stroke (AIS), perfusion imaging, while not directly visualizing collateral vessels, can provide important insight into collateral robustness, indexed by perfusion lesion volume and by perfusion lesion heterogeneity. Two proposed perfusion lesion heterogeneity measures indexing collateral status are the Perfusion Collateral Index (PCI) and Hypoperfusion Intensity Ratio (HIR), but their accuracy compared with direct collateral assessment on DSA has been incompletely characterized. Methods: Consecutive AIS patients with anterior circulation large vessel occlusion who underwent pre-endovascular thrombectomy MRI perfusion imaging were included. MRI measures analyzed were: 1) Perfusion Collateral Index ( PCI) - the volume of moderately hypoperfused tissue (arterial tissue delay time between 2 and 6 seconds: ATD 2-6sec ) multiplied by its corresponding relative cerebral blood volume using Olea software; 2) Hypoperfusion Intensity Ratio (HIR) ratio of moderate TMax >6 s lesion volume versus severe Tmax >10 s lesion volume with the RAPID software program. DSA collateral scores were evaluated by ASITN grading and dichotomized to inadequate (ASTIN <2) vs. adequate (ASTIN ≥3). Results: Among 48 patients meeting entry criteria, age (mean ± SD) was 70 (± 15.2), 54% were female, and NIHSS (median, IQR) was 15 (10-19). For HIR, there was no significant difference in score values in patients with adequate vs inadequate collaterals: 0.35 ± 0.20 vs 0.39 ± 0.25, p=0.68. ROC analysis using previously described cut-off of 0.4 resulted in an AUC of 0.52 and sensitivity/specificity of 71% / 33%. For PCI, score values were significantly higher in patients with adequate vs inadequate collaterals, 117 ± 61 vs. 57 ± 41, p=0.002. ROC analysis using previously described cut-off of 62 resulted in an AUC of 0.8 and sensitivity/specificity of 84% / 78%. Conclusion: Collateral status can be accurately assessed on perfusion MRI with the Perfusion Collateral Index, which outperformed the Hypoperfusion Intensity Ratio. MRI-PCI is an informative imaging biomarker of collateral status in patients with AIS.

Abstract TP38: Core Growth Speed as a Marker of Collateral Circulation Status in Acute Ischemic Stroke with Known Onset Time

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Laura Blanco-García ◽  
Elisa Cortijo ◽  
Mercedes De Lera ◽  
Ana Calleja ◽  
María Usero ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Collateral Circulation ◽  
Cerebral Blood Volume ◽  
Onset Time ◽  
Growth Speed ◽  
Infarct Core ◽  
Anterior Circulation ◽  
Unaffected Side ◽  
Core Volume

Objective: We aimed to evaluate the parameter core growth speed (CGS) as a marker of collateral circulation status (CC) in acute ischemic stroke, and to compare it with other brain perfusion-derived markers of collateral capacity. Methods: We retrospectively studied acute ischemic stroke patients who were evaluated with urgent computed tomography perfusion (CTP) and CT angiography. Inclusion criteria comprised known time of onset and anterior circulation proximal occlusion. Collateral circulation was assessed on CTP-source images and rated as poor (0-1) vs. good (2-3) following a previously published scale. CTP maps were computed using Neuroscape 2.0 software by Olea Medical. Infarct core volume was calculated as the brain tissue with >70% reduction in cerebral blood flow (CBF) as compared to the unaffected side. CGS was obtained by dividing core volume by the time from stroke onset to CTP acquisition. Relative cerebral blood volume (rCBV), relative CBF, and hypoperfusion index ratio (HIR = Tmax>10s/Tmax>6s) were used as comparators. Results: We included 41 patients (mean age 71 years; median NIHSS 17; median onset-CTP time 150 minutes). We observed a positive correlation between CGS and HIR (ρ= 0.517 p< 0.001), and negative correlations between rCBV and CGS (ρ= -0.669 p<0.0001), and rCBF and CGS (ρ= -0.749 p<0.0001). Collateral circulation was categorized as poor or good in 15 and 26 patients respectively. A gradual descend in CGS was seen as CC improved (p=0.0005). A logistic regression model adjusted by rCBV, rCBF and HIR identified CGS as independently associated with CC. The association of CGS with good CC in a ROC curve was highly significant (p=0.002, area under the curve 0.8). Conclusion: Core growth speed is robustly associated with collateral circulation status. This parameter can be directly obtained from infarct core volume without the need to process other perfusion or angiographic images, if the time of onset is well known.

scholarly journals Recent advances in the management of acute ischemic stroke

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 484 ◽  
Author(s):  
Philip Chang ◽  
Shyam Prabhakaran
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Care ◽  
Endovascular Intervention ◽  
Anterior Circulation ◽  
Recent Advances ◽  
Select Group ◽  
Technological Advances

In recent years, several landmark trials have transformed acute ischemic stroke care. The most dramatic results from the field of acute endovascular intervention demonstrate unequivocal benefit for a select group of patients with moderate to severe deficits presenting within 7 hours from onset and with occlusions of proximal arteries in the anterior circulation. In addition, technological advances and workflow efficiencies have facilitated more rapid delivery of acute stroke interventions. This review provides an overview of recent advances in the management of acute ischemic stroke.

Sign in / Sign up

Export Citation Format

Share Document