Abstract TP69: Three-Phase Helical Computed Tomographic Angiography Perfusion Maps Predict Final Infarction in the Acute Ischemic Stroke Setting

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Connor C McDougall ◽  
Erin Maxwell ◽  
Noaah Reaume ◽  
Rani Gupta Sah ◽  
Christopher D d'Esterre ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Computed Tomographic Angiography ◽  
Computed Tomographic ◽  
Three Phase ◽  
Tomographic Angiography ◽  
Perfusion Maps

scholarly journals Successful recanalization using the Embolus Retriever with Interlinked Cage for acute stroke due to calcified cerebral emboli

2018 ◽  
Vol 24 (6) ◽  
pp. 674-677 ◽  
Author(s):  
Hyo S Kwak ◽  
Jung S Park
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Thrombolytic Agent ◽  
Mechanical Thrombectomy ◽  
Computed Tomographic Angiography ◽  
Sudden Onset ◽  
Aspiration Thrombectomy ◽  
Computed Tomographic ◽  
Tomographic Angiography ◽  
Left Middle

Mechanical thrombectomy is a safe and effective treatment in patients with acute ischemic stroke caused by large vessel occlusions. However, in rare cases, the procedure may be challenging due to the composition of the embolus. We describe a case of a mechanical thrombectomy with the Embolus Retriever with Interlinked Cage (ERIC) device in a patient with an acute ischemic stroke due to calcified cerebral emboli in the middle cerebral artery. The procedure was done after a failed recanalization attempt with manual aspiration thrombectomy. An 82-year-old woman presented to the emergency department with a sudden onset of right-sided weakness. A computed tomographic angiography showed left middle cerebral (M1 branch) calcified emboli. After the administration of an intravenous thrombolytic agent, the patient was transferred to the angiographic suite for a mechanical thrombectomy. After failure to recanalize the vessel with manual aspiration thrombectomy, successful recanalization was achieved via mechanical thrombectomy using the ERIC device. Mechanical thrombectomy with an ERIC device can be a useful option in cases of acute ischemic stroke caused by calcified cerebral emboli.

scholarly journals Automated Prediction of Ischemic Brain Tissue Fate from Multiphase Computed Tomographic Angiography in Patients with Acute Ischemic Stroke Using Machine Learning

2021 ◽  
Vol 23 (2) ◽  
pp. 234-243
Author(s):  
Wu Qiu ◽  
Hulin Kuang ◽  
Johanna M. Ospel ◽  
Michael D. Hill ◽  
Andrew M. Demchuk ◽  
...  
Keyword(s):  
Machine Learning ◽  
Computed Tomography ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Tissue Perfusion ◽  
Computed Tomographic Angiography ◽  
Perfusion Abnormality ◽  
Computed Tomographic ◽  
Tomographic Angiography

Background and Purpose Multiphase computed tomographic angiography (mCTA) provides time variant images of pial vasculature supplying brain in patients with acute ischemic stroke (AIS). To develop a machine learning (ML) technique to predict tissue perfusion and infarction from mCTA source images.Methods 284 patients with AIS were included from the Precise and Rapid assessment of collaterals using multi-phase CTA in the triage of patients with acute ischemic stroke for Intra-artery Therapy (Prove-IT) study. All patients had non-contrast computed tomography, mCTA, and computed tomographic perfusion (CTP) at baseline and follow-up magnetic resonance imaging/non-contrast-enhanced computed tomography. Of the 284 patient images, 140 patient images were randomly selected to train and validate three ML models to predict a pre-defined Tmax thresholded perfusion abnormality, core and penumbra on CTP. The remaining 144 patient images were used to test the ML models. The predicted perfusion, core and penumbra lesions from ML models were compared to CTP perfusion lesion and to follow-up infarct using Bland-Altman plots, concordance correlation coefficient (CCC), intra-class correlation coefficient (ICC), and Dice similarity coefficient.Results Mean difference between the mCTA predicted perfusion volume and CTP perfusion volume was 4.6 mL (limit of agreement [LoA], –53 to 62.1 mL; <i>P</i>=0.56; CCC 0.63 [95% confidence interval [CI], 0.53 to 0.71; <i>P</i><0.01], ICC 0.68 [95% CI, 0.58 to 0.78; <i>P</i><0.001]). Mean difference between the mCTA predicted infarct and follow-up infarct in the 100 patients with acute reperfusion (modified thrombolysis in cerebral infarction [mTICI] 2b/2c/3) was 21.7 mL, while it was 3.4 mL in the 44 patients not achieving reperfusion (mTICI 0/1). Amongst reperfused subjects, CCC was 0.4 (95% CI, 0.15 to 0.55; <i>P</i><0.01) and ICC was 0.42 (95% CI, 0.18 to 0.50; <i>P</i><0.01); in non-reperfused subjects CCC was 0.52 (95% CI, 0.20 to 0.60; <i>P</i><0.001) and ICC was 0.60 (95% CI, 0.37 to 0.76; <i>P</i><0.001). No difference was observed between the mCTA and CTP predicted infarct volume in the test cohort (<i>P</i>=0.67).Conclusions A ML based mCTA model is able to predict brain tissue perfusion abnormality and follow-up infarction, comparable to CTP.

Abstract T P177: Non-dominant Vertebral Artery With Higher Resistance Flow Pattern Is A Risk Factor For Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Leonard yeo ◽  
Amit Batra ◽  
Ashley Tan ◽  
Song Majinyang ◽  
Darren Low ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Flow Pattern ◽  
Posterior Inferior Cerebellar Artery ◽  
Computed Tomographic Angiography ◽  
Mean Flow ◽  
Computed Tomographic ◽  
Vertebral Arteries ◽  
Cerebellar Artery ◽  
Intracranial Arteries ◽  
Tomographic Angiography

Background and aims: The diameters of the vertebral arteries (VAs) are very often unequal and the larger artery is called ‘dominant’. We investigated whether the hemodynamic parameters differ between the ‘dominant’ and ‘non-dominant’ variants. Methods: Consecutive patients who underwent computed tomographic angiography (CTA) of cervical and intracranial arteries, cervical duplex (CDU) and transcranial Doppler (TCD) ultrasonography were included. VA diameters (cervical and intracranial segments) were measured on CTA. Flow velocities recorded were peak systolic (PSV), end-diastolic (EDV), mean flow (MFV). Pulsatility index (PI) and ratio of distal-to-proximal VAs were computed. Results: Of the total 501 patients admitted during 2012 with acute ischemic stroke, both CTA and ultrasound data were available for VAs for 161 (32%). The dominant VA was more frequent on the left side (p<0.01). Non-dominant VAs were found to have lower MFV (27cm/s versus 38cm/s; p<0.01) and higher PI (1.27 versus 1.0; p<0.01) as compared to the dominant variant. In most patients, proximal basilar artery was noted to be on the side of non-dominant artery. Posterior inferior cerebellar artery territory infarcts and lateral medullary infarcts were noted in 38 (7.6%) patients. These infarcts were noted more commonly on the same side as the non-dominant intracranial VA side (p<0.01), especially when associated with low MFV (p<0.01) and high PI (p<0.01). Conclusions: The risk of ischemic stroke in VA territory is higher with the non-dominant artery, especially when it is associated with higher-resistance flow pattern.

scholarly journals Routine CT Angiography in Acute Stroke Does Not Delay Thrombolytic Therapy

2012 ◽  
Vol 39 (4) ◽  
pp. 499-501 ◽  
Author(s):  
Simerpreet Bal ◽  
Bijoy K. Menon ◽  
Andrew M. Demchuk ◽  
Michael D. Hill ◽  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Linear Regression Analysis ◽  
Computed Tomographic Angiography ◽  
University Hospital ◽  
Computed Tomographic ◽  
Multivariable Linear Regression Analysis ◽  
Group 2 ◽  
Contrast Ct ◽  
Group 1

Introduction:Lack of additional utility over non-contract computed tomography (NCCT) in decision making and delay in door to needle time are arguments used against routine computed tomographic angiography (CTA) use in acute ischemic stroke management. We compare interval times during a CTA based acute ischemic stroke protocol with an earlier non-CTA based protocol at our center.Methods:We reviewed 850 stroke thrombolysis patients in a university hospital in Canada from April 1996 to December 2009. Time to treatment was divided into the following interval times: onset-to-door, door-to-needle and onset-to-needle. Patients were categorized into: Group 1 (April 1996-Dec 2002) (Non-contrast CT Scan based thrombolysis) n=297, Group 2 (Jan 2004-Dec 2009) (CTA based thrombolysis) n=504. The period from Jan to Dec 2003 (n=49) was considered a washout period as we had started the CTA protocol that year. Interval times were compared between the two groups.Results:Interval times in Group 1 and Group 2 were: median onset-to-door times in Group 1 [55 minutes (IQR 48),] and Group 2 [61 minutes (IQR 57)] (p=0.019); median door-to-needle times in Group 1 [67 minutes(IQR 43)] and Group 2 [62.5 minutes (IQR 52)] (p=0.519); median onset-to-needle times in Group 1 (139 minutes (IQR 73)] and Group 2 (141.5 min (IQR 109.5) (p=0.468). In multivariable linear regression analysis, age and onset-to-door time influenced the door-to-needle time. For every decade of age, door-to-needle times were 5.4 minutes faster.Conclusions:CTA based thrombolytic approach for acute ischemic stroke does not significantly delay thrombolysis in routine clinical practice.

Sign in / Sign up

Export Citation Format

Share Document