Abstract WP82: Ghost Infarct Core: Ischemic Oreoverestimation by Admission CT Perfusion on Large Vessel Occlusion Stroke Patients

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Gabriel M Rodrigues ◽  
Michael Frankel ◽  
Diogo C Haussen ◽  
Raul G Nogueira
Keyword(s):  
Ct Perfusion ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Infarct Core ◽  
Vessel Occlusion

scholarly journals Performance of angiographic parametric imaging in locating infarct core in large vessel occlusion acute ischemic stroke patients

2020 ◽  
Vol 7 (01) ◽  
pp. 1
Author(s):  
Ryan A. Rava ◽  
Maxim Mokin ◽  
Kenneth V. Snyder ◽  
Muhammad Waqas ◽  
Adnan H. Siddiqui ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Large Vessel ◽  
Parametric Imaging ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Infarct Core ◽  
Vessel Occlusion

Abstract TP61: The Predictive Ability of Aspects vs Ct Perfusion for Large-vessel Occlusions Less Than 6 Hours

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Monika Manchanda ◽  
Justin Moore ◽  
John Leever ◽  
Luke Ledbetter ◽  
Sabreena Slavin ◽  
...  
Keyword(s):  
Ct Perfusion ◽  
Predictive Ability ◽  
Diagnostic Odds Ratio ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Infarct Core ◽  
Vessel Occlusion ◽  
The Mean ◽  
Selection Of ◽  
Better Than

Background: While CT perfusion (CTP) has become invaluable in the selection of acute ischemic stroke patients for endovascular therapy (EVT) ≥6 hours of symptom onset, there continues to be uncertainty in its role within 6 hours. Hypothesis: CTP will select patients for EVT better than ASPECTS - as RAPID software can provide quantitative volumetric thresholds, while ASPECTS is subject to interpersonal variability. Methods: Patients over 18 years old with last known well (LKW) time to imaging less than 6 hours, and a confirmed large-vessel occlusion at the ICA, M1 or M2 were reviewed retrospectively. ASPECTS ratings were assessed by two blinded neuroradiologists. A diagnostic odds ratio (OR) was calculated by dichotomizing ASPECTS ≥6 vs <6, and comparing to the modified Rankin score (mRS) ≤0-2 vs >2. A separate diagnostic OR was calculated for CTP by dichotomizing the infarct core (cerebral blood flow (CBF) <30%) ≤50 ml vs >50 ml. Results: Ninety-six subjects were evaluated. Mean age was 65.4±14, 42% female, presenting with a mean NIHSS 16.4±8, 65% were treated with IV tPA, and mean clot retrieval was 5.3±2 hours for those who underwent EVT (70/96). The mean ASPECTS was 7.6±2, and mean infarct core (CBF<30%) of 34.4±50. Inter-rater reliability for ASPECTS grading was ICC=0.797 (95%CI 0.378-0.932). ASPECTS and CTP were found to be in agreement in 83.3% (80/96) of cases on whether or not to pursue EVT. In incongruent cases, in which ASPECTS was favorable but CTP was unfavorable - 54% (6/11) had mRS between 4-6, and similarly 50% (8/16) had a poor mRS when CTP was favorable but ASPECTS was unfavorable. In general, both ASPECTS and CTP poorly correlated with the utility-mRS (r = 0.14 and r = -0.15 respectively) when controlling for age, sex, time (LKW-to-CTP), and treatment (EVT± tPA, tpA alone, or none). Overall, diagnostic OR for prediction of a good outcome (mRS 0-2) for ASPECTS was 1.5 (95% CI 0.4-4.5) vs 3.4 for CTP (95% CI of 1.2-9.2), p=0.29. When accounting for treatment subtype, the diagnostic OR was 1.2 (0.4-3.6) for ASPECTS vs 2.9 for CTP (1.1-8.1), p=0.24. Conclusion: Approximately 1:6 patients will have incongruent results between ASPECTS and CTP. ASPECTS was not significantly better than CTP in cases <6 hours. In fact, a trend for better predictive ability was seen with CTP.

Abstract TP76: Quantitative Comparison of Multidetector CT and Cone-Beam CT Perfusion Maps in Large Vessel Occlusion Stroke Patients Undergoing Mechanical Thrombectomy

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Santiago Ortega-Gutierrez ◽  
Darko Quispe-Orozco ◽  
Sebastian Schafer ◽  
Beverly Aagaard Kienitz ◽  
Charles Strother ◽  
...  
Keyword(s):  
Multidetector Ct ◽  
Ct Perfusion ◽  
Intraclass Correlation ◽  
Large Vessel ◽  
Cone Beam ◽  
Moderate Degree ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Affected Area

Cerebral perfusion evaluation using CT or MR perfusion is the gold standard modality to select large vessel occlusion (LVO) stroke patients presenting >6 hours from symptom onset. The availability of cone beam C-arm CT perfusion (CBCTP) in angiography suites could reduce time to endovascular revascularization. We aimed to evaluate the reliability of using CBCTP when compared to multidetector CT perfusion (MDCTP). In this prospective, single-arm, interventional study, 14 LVO anterior circulation thrombectomy patients underwent both a 128 slice MDCTP in the ED and a CBCTP <30 minutes apart prior to groin puncture. CBCTP was acquired using a prototype acquisition mode enabling 10 consecutive C-Arm rotations with nearly continuous data acquisition. A total of 60 cc of contrast layered with 60 cc of saline were injected covering arterial inflow, parenchymal phase and venous outflow. Image data was reconstructed into CBF, CBV, MTT and TTP maps. Three types of measurements were used to compare modalities. In measurement 1, 6 circular regions of interest (ROI) (400mm 2 ) were placed in the anterior arterial territory. In measurement 2, circular ROIs were placed in the ASPECTS regions (cortical 300mm 2 , subcortical 200mm 2 ). In measurement 3, a ROI was drawn around the entire affected area. All ROIs were placed in the basal ganglia and supraganglionic level of both brain sides. Rates (unaffected/affected area) between MDCTP and CBCTP were compared for all sequences. The intraclass correlation coefficient (ICC) was calculated using a single rater, consistency, two-way random-effects model. Measurement 1 found a moderate degree of agreement between MDCTP and CBCTP in CBF, CBV, MTT and TTP rates with ICCs of 0.58 (CI 0.42 - 0.69), 0.65 (CI 0.53 - 0.74), 0.77 (CI 0.68 - 0.83) and 0.52 (CI 0.35 - 0.65). In measurement 2, moderate agreement was found in CBF, CBV and MTT rates; with ICCs of 0.51 (CI 0.32 - 0.65), 0.57 (CI 0.4 - 0.69) and 0.62 (CI 0.47 - 0.73). The results of measurement 3 found an excellent (ICC=0.95, CI 0.88 - 0.98), good (ICC=0.83, CI 0.62 - 0.9) and moderate (ICC=0.7, CI 0.34 - 0.87), degree of agreement in the CBV, MTT and CBF rates, respectively. These results demonstrate promising accuracy of CBCTP in the evaluating ischemic tissue in patient presenting with LVO acute stroke.

scholarly journals Performance of Automated Attenuation Measurements at Identifying Large Vessel Occlusion Stroke on CT Angiography

2020 ◽  
Author(s):  
Paul Reidler ◽  
Lena Stueckelschweiger ◽  
Daniel Puhr-Westerheide ◽  
Katharina Feil ◽  
Lars Kellert ◽  
...  
Keyword(s):  
Visual Analysis ◽  
Ct Perfusion ◽  
Characteristic Curve ◽  
Large Vessel ◽  
Youden Index ◽  
Control Group ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Number Of Patients

Abstract Purpose Computed tomography angiography (CTA) is routinely used to detect large-vessel occlusion (LVO) in patients with suspected acute ischemic stroke; however, visual analysis is time consuming and prone to error. To evaluate solutions to support imaging triage, we tested performance of automated analysis of CTA source images (CTASI) at identifying patients with LVO. Methods Stroke patients with LVO were selected from a prospectively acquired cohort. A control group was selected from consecutive patients with clinically suspected stroke without signs of ischemia on CT perfusion (CTP) or infarct on follow-up. Software-based automated segmentation and Hounsfield unit (HU) measurements were performed on CTASI for all regions of the Alberta Stroke Program Early CT score (ASPECTS). We derived different parameters from raw measurements and analyzed their performance to identify patients with LVO using receiver operating characteristic curve analysis. Results The retrospective analysis included 145 patients, 79 patients with LVO stroke and 66 patients without stroke. The parameters hemispheric asymmetry ratio (AR), ratio between highest and lowest regional AR and M2-territory AR produced area under the curve (AUC) values from 0.95–0.97 (all p < 0.001) for detecting presence of LVO in the total population. Resulting sensitivity (sens)/specificity (spec) defined by the Youden index were 0.87/0.97–0.99. Maximum sens/spec defined by the specificity threshold ≥0.70 were 0.91–0.96/0.77–0.83. Performance in a small number of patients with isolated M2 occlusion was lower (AUC: 0.72–0.85). Conclusion Automated attenuation measurements on CTASI identify proximal LVO stroke patients with high sensitivity and specificity. This technique can aid in accurate and timely patient selection for thrombectomy, especially in primary stroke centers without CTP capacity.

Abstract WP82: Evaluation of Infarct Core Determination in Patients With Large Vessel Occlusion

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Victor Lopez-Rivera ◽  
James Fan ◽  
Songmi Lee ◽  
Aditya Kumar ◽  
Mehmet Enes Inam ◽  
...  
Keyword(s):  
Ct Perfusion ◽  
Infarct Volume ◽  
Large Vessel ◽  
Late Time ◽  
Large Vessel Occlusion ◽  
Mri Findings ◽  
Infarct Core ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Optimal Method

Introduction: Estimation of infarct core (IC) is a critical component in the evaluation of patients with large vessel occlusion (LVO) for endovascular stroke therapy (EST), but the optimal method to determine IC is uncertain. Methods: From our prospectively maintained institutional registry, we identified acute ischemic stroke (AIS) patients with LVO between 1/2018 and 2/2019. Patients were included if they underwent consecutively and technically adequate non-contrast CT, CT angiography (CTA), and CT Perfusion (CTP). ASPECTS was assessed by an experienced neuroradiologist. CTP IC was determined using RAPID. Final infarct volume (FIV) was determined by manual volume segmentation on DWI sequences from 24h MRI, but this analysis was limited to patients who underwent EST with TICI 2b/3 reperfusion within 120 minutes of presentation CT imaging, to minimize IC growth affecting the results. Correlation between IC measurements was calculated using Spearman p. Results are provided as median [IQR]. Results: Among 772 patients with LVO, 199 patients met inclusion criteria. Median age was 69 [59-79], 47% were female and 57% were white. Median NIHSS was 15 [9-21], the most common occlusion site was M1 MCA (55%). Median CT ASPECTS was 7 [6-9], median CTA ASPECTS was 6 [5-7], and median CTP-RAPID IC volume was 11 [0-47]. Presentation CT ASPECTS correlated with CTP-RAPID IC (Fig. 1A, r=-0.57; p<0.0001), as did CTA ASPECTS (Fig. 1B, r=-0.61; p<0.0001). Presentation CTA ASPECTS correlated with CTP-RAPID IC in patients presenting 0-6 hrs (CTA r=-0.69; p<0.0001) and 6-24 hrs (r=-0.58; p<0.0001). Among 90 patients with EST and TICI 2b/3, presentation CTA ASPECTS correlated better with FIV (r=-0.65; p<0.0001) compared to presentation CTP-RAPID (r=0.61; p<0.0001). Conclusions: In patients with LVO in the anterior circulation, CTA ASPECTS correlated well with CTP-RAPID IC in the early and late time windows, and was more reflective of 24h MRI findings in patients who received EST.

scholarly journals Factors associated with prominent vessel sign on susceptibility-weighted imaging in acute ischemic stroke

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hai-fei Jiang ◽  
Yi-qun Zhang ◽  
Jiang-xia Pang ◽  
Pei-ning Shao ◽  
Han-cheng Qiu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Large Vessel ◽  
Susceptibility Weighted Imaging ◽  
Regression Analyses ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Factors Associated ◽  
Univariate Analyses

AbstractThe prominent vessel sign (PVS) on susceptibility-weighted imaging (SWI) is not displayed in all cases of acute ischemia. We aimed to investigate the factors associated with the presence of PVS in stroke patients. Consecutive ischemic stroke patients admitted within 24 h from symptom onset underwent emergency multimodal MRI at admission. Associated factors for the presence of PVS were analyzed using univariate analyses and multivariable logistic regression analyses. A total of 218 patients were enrolled. The occurrence rate of PVS was 55.5%. Univariate analyses showed significant differences between PVS-positive group and PVS-negative group in age, history of coronary heart disease, baseline NIHSS scores, total cholesterol, hemoglobin, anterior circulation infarct, large vessel occlusion, and cardioembolism. Multivariable logistic regression analyses revealed that the independent factors associated with PVS were anterior circulation infarct (odds ratio [OR] 13.7; 95% confidence interval [CI] 3.5–53.3), large vessel occlusion (OR 123.3; 95% CI 33.7–451.5), and cardioembolism (OR 5.6; 95% CI 2.1–15.3). Anterior circulation infarct, large vessel occlusion, and cardioembolism are independently associated with the presence of PVS on SWI.

scholarly journals Epidemiological Surveillance of the Impact of the COVID-19 Pandemic on Stroke Care Using Artificial Intelligence

Stroke ◽  
2021 ◽  
Author(s):  
Raul G. Nogueira ◽  
Jason M. Davies ◽  
Rishi Gupta ◽  
Ameer E. Hassan ◽  
Thomas Devlin ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Acute Stroke ◽  
Systems Of Care ◽  
Ct Perfusion ◽  
Stroke Care ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Number Of Patients ◽  
The Impact

Background and Purpose: The degree to which the coronavirus disease 2019 (COVID-19) pandemic has affected systems of care, in particular, those for time-sensitive conditions such as stroke, remains poorly quantified. We sought to evaluate the impact of COVID-19 in the overall screening for acute stroke utilizing a commercial clinical artificial intelligence platform. Methods: Data were derived from the Viz Platform, an artificial intelligence application designed to optimize the workflow of patients with acute stroke. Neuroimaging data on suspected patients with stroke across 97 hospitals in 20 US states were collected in real time and retrospectively analyzed with the number of patients undergoing imaging screening serving as a surrogate for the amount of stroke care. The main outcome measures were the number of computed tomography (CT) angiography, CT perfusion, large vessel occlusions (defined according to the automated software detection), and severe strokes on CT perfusion (defined as those with hypoperfusion volumes >70 mL) normalized as number of patients per day per hospital. Data from the prepandemic (November 4, 2019 to February 29, 2020) and pandemic (March 1 to May 10, 2020) periods were compared at national and state levels. Correlations were made between the inter-period changes in imaging screening, stroke hospitalizations, and thrombectomy procedures using state-specific sampling. Results: A total of 23 223 patients were included. The incidence of large vessel occlusion on CT angiography and severe strokes on CT perfusion were 11.2% (n=2602) and 14.7% (n=1229/8328), respectively. There were significant declines in the overall number of CT angiographies (−22.8%; 1.39–1.07 patients/day per hospital, P <0.001) and CT perfusion (−26.1%; 0.50–0.37 patients/day per hospital, P <0.001) as well as in the incidence of large vessel occlusion (−17.1%; 0.15–0.13 patients/day per hospital, P <0.001) and severe strokes on CT perfusion (−16.7%; 0.12–0.10 patients/day per hospital, P <0.005). The sampled cohort showed similar declines in the rates of large vessel occlusions versus thrombectomy (18.8% versus 19.5%, P =0.9) and comprehensive stroke center hospitalizations (18.8% versus 11.0%, P =0.4). Conclusions: A significant decline in stroke imaging screening has occurred during the COVID-19 pandemic. This analysis underscores the broader application of artificial intelligence neuroimaging platforms for the real-time monitoring of stroke systems of care.

scholarly journals Mechanical Thrombectomy for Minor Stroke Patients (NIHSS <6) With Large Vessel Occlusion

2018 ◽  
Vol 24 (2) ◽  
pp. 67-70
Author(s):  
Çetin Kürşad Akpınar ◽  
Erdem Gürkaş ◽  
Emrah Aytaç ◽  
Murat Çalık
Keyword(s):  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Minor Stroke ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion

Abstract TP77: Impact of Time and Aspects on Clinical Core Mismatch in Large Vessel Occlusion Strokes

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Shashvat Desai ◽  
Bradley J Molyneaux ◽  
Marcelo Rocha ◽  
Matthew Starr ◽  
Tudor G Jovin ◽  
...  
Keyword(s):  
Patient Selection ◽  
Time Window ◽  
Ct Perfusion ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Ct Head ◽  
Ischemic Core ◽  
The Impact ◽  
Core Volume

Introduction: Patient selection for endovascular thrombectomy (EVT) for anterior circulation large vessel occlusion (LVO) strokes in the 6-24-hour time window is dependent on delineating clinical core mismatch (CCM) as defined by DAWN trial criteria. In contrast, patient selection in the early window (0-6 hours) can be performed using ASPECTS on CT head. We aim to determine the prevalence of DAWN-CCM in LVO strokes and the impact of time and ASPECTS. Methods: Retrospective analysis of large vessel occlusion [internal carotid and middle cerebral artery-M1] strokes at a CSC. Consecutive patients who underwent CT perfusion or MRI within 120 minutes of CT head were included in the study (treated and untreated). Ischemic core volume was assessed using RAPID [IschemaView] and ASPECTS using automated ASPECTS [Brainomix]. CCM was defined using DAWN trial criteria [DAWN-CCM: NIHSS ≥10 and core <31 ml, NIHSS ≥20 and core <51 ml]. Results: A total of 116 patients were included. Mean age was 71 ±14 and 62% were females. Mean ischemic core volume and median ASPECTS were 46 ±65 ml and 8 (6-9), respectively. In patients with NIHSS score ≥10 (98), 57% had DAWN-CCM in the 0-24-hour window. Proportion of patients with DAWN-CCM in 6-24-hour window was 70% (6-12 hours), 50% (12-18 hours), and 50% (18-24 hours) [p=0.35]. Proportion of patients with DAWN-CCM by ASPECTS group was 88% (ASPECTS 9-10), 64% (ASPECTS 6-8) and 13% (ASPECTS 0-5) [p=<0.01] (Figure 1). Probability of DAWN-CCM declines by 7% for every 2 hours increase in TLKW to imaging, and by 13% for every 1-point decrease in ASPECTS. Conclusion: Approximately 57% of LVO strokes have clinical core mismatch. LVO strokes with DAWN-CCM decline with increasing time and decreasing ASPECTS. ASPECTS alone may be sufficient to identify patients with DAWN-CCM in a resource limited setting and avoid time consuming advanced imaging.

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