Abstract P355: Real-Word Performance of Two Automated Software Platforms for Identification of Salvageable Tissue in Stroke Patients: A Single Center Experience

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Angelos Katramados ◽  
Horia Marin ◽  
Maximilian Kole ◽  
Owais Alsrouji ◽  
Pala Varun ◽  
...  
Keyword(s):  
Ct Perfusion ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Significant Discrepancy ◽  
Endovascular Thrombectomy ◽  
Stroke Treatment ◽  
Software Platforms ◽  
Automated Software ◽  
Selection Of Patients ◽  
Selection Of

Background and purpose: Modern stroke treatment has been revolutionized by image-guided selection of patients for endovascular thrombectomy. Current automated platforms allow for real-time identification of large vessel occlusion and salvageable brain tissue. We sought to evaluate the performance of these platforms with regard to identification of infarcted and salvageable tissue. Methods: We studied all patients that presented to Henry Ford Health System hospitals over a period of 6 weeks, received CT perfusion imaging of the brain upon initial presentation. The images were processed with two automated software platforms. We prospectively measured volumes of tissue with cerebral blood flow (CBF) < 30% of contralateral hemisphere, Tmax >6 secs, and hypoperfusion indices (defined as the ratio of volumes Tmax>10 secs and Tmax>6 secs). We compared the outputs of the two platforms and analyzed the performance of each platform. Results: 66 scans were included in our study. Both platforms were able to image all stroke patients within their FDA-approved indications. With regard to all scans, both platforms were noted to demonstrate comparable CBF<30% volumes (6.32 ml. vs 4.97 ml, p=0.276), and hypoperfusion indices (0.278 vs 0.338, p=0.344). However, there was statistically significant discrepancy in the volumes of tissue with Tmax>6 secs (23.96 vs 14.18 ml, p=0.023). Analysis of a subset of 12 scans, with evidence of LVO or severe symptomatic stenosis on corresponding CTA, showed again comparable CBF<30% volumes (12.84 ml vs 13.67 ml, p=0.725), and hypoperfusion indices (0.344 vs 0.314, p=0.699). However, the Tmax>6 secs volume discrepancy was greater and still statistically significant (75.54 ml vs 39.58 ml, p=0.048) Conclusions: Automated software platforms are an invaluable aid in the identification of salvageable tissue, and selection of patients for endovascular thrombectomy in the 6-24 hour window. However, the substantial difference in the identified volumes of hypoperfused tissue-at-risk may result in largely different clinical decisions and patient outcomes. Further validation efforts (and harmonization of algorithms) are required. Stroke teams should be aware of the limitations of automated analysis and need for expert review.

Abstract P377: Real-Word Performance of Two Automated Software Platforms for Large-Vessel Occlusion Identification in Acute Ischemic Stroke Patients: A Single Center Experience

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Angelos M Katramados ◽  
Maximilian Kole ◽  
Horia Marin ◽  
Owais Alsrouji ◽  
Pala Varun ◽  
...  
Keyword(s):  
Large Vessel ◽  
Test Accuracy ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Software Platforms ◽  
Automated Software ◽  
Selection Of Patients ◽  
Selection Of

Background and purpose: Modern stroke treatment has been revolutionized by image-guided selection of patients for endovascular thrombectomy. Current automated platforms allow for real-time identification of large vessel occlusion and salvageable brain tissue. We had previously demonstrated that a “CTA for all” policy for stroke patients immediately upon arrival assists in the earlier identification of treatment candidates. We now sought to evaluate the performance of these platforms under this policy. Methods: All patients that presented to Henry Ford Health System hospitals over a period of 6 weeks received CTA of the head and neck upon initial presentation. The images were processed with two automated software platforms. We prospectively collected processing times, large-vessel-occlusion alerts, performance warnings, and LVO density ratios. We compared these with the interpretations of board-certified radiologists, and analyzed the performance of each platform. Results: 276 patients presented with stroke symptoms and received CT angiography upon presentation. Both platforms were able to image all stroke patients within their FDA-approved indications. Both platforms were noted to have comparable sensitivity, specificity, PPV and NPV, and excellent accuracy. The overall prevalence of LVO was extremely low (8/276). As a result, for both, NPV was much better than PPV because of the percentage of false positive results. Further ROC analysis, demonstrated an area under the ROC curve of 0.982, and overall model quality of 0.97. Optimal LVO density cutoff was <0.093 in order to maximize overall accuracy, or < 0.271, in order to maintain a sensitivity of 100% as an absolute priority (both significantly lower than the current threshold of <0.45). Conclusions: Automated software platforms are an invaluable aid in the selection of patients for endovascular thrombectomy. Different LVO detection algorithmic thresholds may be necessary (and should be part of individual stroke center validation pathways) to avoid fatigue alert, and optimize test accuracy, when LVO prevalence is low. Stroke teams should be aware of the limitations of automated analysis and need for expert review.

scholarly journals Acute Ischemic Stroke: A Review of Imaging, Patient Selection, and Management in the Endovascular Era. Part II: Patient Selection, Endovascular Thrombectomy, and Postprocedure Management

2018 ◽  
Vol 02 (03) ◽  
pp. 169-183
Author(s):  
Sharath Kumar G G ◽  
Chinmay Nagesh
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Patient Selection ◽  
Secondary Brain Injury ◽  
Selection Methods ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Advantages And Disadvantages ◽  
Imaging Patient ◽  
Selection Of

AbstractAppropriate patient selection and expedient recanalization are the mainstay of modern management of acute ischemic stroke (AIS). Only a minority of patients (7–15%) of patients are eligible for endovascular therapy. Patient selection may be time based or perfusion based. Central to both paradigms is the selection of a patient with a small core, a significant penumbra that can be differentiated from areas of oligemia. A brief review of patient selection methods is presented. Endovascular thrombectomy techniques using stentrievers or aspiration catheters have now become the treatment of choice for AIS with large vessel occlusion. A range of devices, each with its own advantages and disadvantages, are available in the market for the neurointerventionist to choose. Techniques vary between devices and between operators, but standardization and protocolization are important within each center. Complications must be anticipated to be avoided. Once reperfusion is achieved, outcomes must be safeguarded with competent postprocedure management to prevent secondary brain injury. These aspects are reviewed in this article.

Abstract P542: Management and Outcome of Stroke Patients With Tandem Carotid Occlusion in the ESCAPE NA1-Trial

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Martha Marko ◽  
Petra Cimflova ◽  
Nishita Singh ◽  
Johanna Ospel ◽  
Nima Kashani ◽  
...  
Keyword(s):  
Treatment Strategies ◽  
Carotid Stenting ◽  
Carotid Occlusion ◽  
Catheter Angiography ◽  
Stroke Patients ◽  
Treatment Allocation ◽  
Tandem Occlusion ◽  
Stent Treatment ◽  
Selection Of Patients ◽  
Selection Of

Background: The optimal treatment for stroke patients with tandem cervical carotid occlusion is debated. We analyzed the treatment strategies and outcomes of tandem occlusion patients in the ESCAPE NA1 trial. Methods: ESCAPE NA1 was a multicenter international randomized trial of nerinetide vs. placebo in patients with acute ischemic stroke who underwent EVT. We defined tandem occlusions as complete occlusion of the cervical ICA on catheter angiography. The influence of tandem occlusions on outcome was analyzed using regression modeling with adjustment for age, sex, baseline NIHSS and ASPECTS, occlusion location, thrombolysis and treatment allocation. Results: 115 of 1105 patients (10.4%) had tandem occlusions. 73/115 tandem patients (66.0%) received treatment for the cervical occlusion: 21.9% were stented before thrombectomy, 68.5% were stented after thrombectomy, and 8.2% had angioplasty alone. Successful reperfusion was significantly higher in patients who had thrombectomy first followed by carotid treatment (eTICI 2b-3: 40/40 (100.0%)) or carotid angioplasty before and cervical stent after intracranial thrombectomy (9/10 (90.0%)) compared to carotid intervention before intracranial thrombectomy: (19/23 (82.1%), p=0.016). 90-day mRS 0-2 was achieved in 82/115 patients (71.3%) with tandem occlusions (treated occlusions: 74.0%, untreated: 66.7%) compared to 579/981 (59.5%) patients without tandem occlusions. In adjusted analysis, tandem occlusion was not predictive of outcome. In the subgroup of tandem patients, cervical stent-treatment was nominally associated with better outcomes (OR 2.2, 95% CI 0.5 - 9.2). Conclusion: Cervical carotid stenting may improve outcomes for EVT patients with tandem occlusions, but these results are limited by the sample size and non-randomized selection of patients for stenting.

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

Advanced neuroimaging in acute ischemic stroke: extending the time window for treatment

2011 ◽  
Vol 30 (6) ◽  
pp. E5 ◽  
Author(s):  
E. Jesus Duffis ◽  
Zaid Al-Qudah ◽  
Charles J. Prestigiacomo ◽  
Chirag Gandhi
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Perfusion Imaging ◽  
Time Window ◽  
Thrombolytic Treatment ◽  
Stroke Patients ◽  
Improved Outcomes ◽  
Potential Applications ◽  
Selection Of Patients ◽  
Selection Of

Early treatment of ischemic stroke with thrombolytics is associated with improved outcomes, but few stroke patients receive thrombolytic treatment in part due to the 3-hour time window. Advances in neuroimaging may help to aid in the selection of patients who may still benefit from thrombolytic treatment beyond conventional time-based guidelines. In this article the authors review the available literature in support of using advanced neuroimaging to select patients for treatment beyond the 3-hour time window cutoff and explore potential applications and limitations of perfusion imaging in the treatment of acute ischemic stroke.

scholarly journals Inverse National Trends in Decompressive Craniectomy Versus Endovascular Thrombectomy for Stroke

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Nicolas K Khattar ◽  
Beatrice Ugiliweneza ◽  
Mayur Sharma ◽  
Enzo Fortuny ◽  
Shawn William Adams ◽  
...  
Keyword(s):  
Decompressive Craniectomy ◽  
Recent Decade ◽  
The United States ◽  
Hospital Charges ◽  
Utilization Rate ◽  
Study Cohort ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Stroke Treatment ◽  
National Trends

Abstract INTRODUCTION Endovascular thrombectomy (ET) for acute large vessel occlusion reduces infarct size, and it should hypothetically decrease the incidence of major ischemic strokes requiring decompressive craniectomy (DC). The aim of this retrospective cohort study is to determine trends in the utilization of ET versus DC for stroke in the United States over a 10-yr span. METHODS We extracted data from the Nationwide Inpatient Sample (NIS) using ICD-9/10 codes for the time period 2006 to 2016. Patients with a primary diagnosis of stroke and a concurrent procedure code for ET or DC were included. Baseline demographics, outcomes and hospital charges were analyzed. RESULTS The study cohort comprised 187 355 patients diagnosed with stroke who underwent either ET or DC. The number of ET- or DC-treated stroke patients increased by 266% from 2006 to 2016. During the study period, the ET utilization rate increased (2.7% in 2006 to 68.6% in 2016, P < .0001) and the DC utilization rate decreased (97.3% in 2006 to 31.4% in 2016, P < .0001). In 2015, the utilization rate of ET (50.2%) exceeded that of DC (49.8%). ET-treated patients had shorter durations of hospital stay (mean 8.8 vs 16.8 days, P < .0001), decreased mortality (16.2% vs 19.3%), higher likelihood of discharge home (27.1% vs 24.1%, P < .0001), and lower hospital charges (mean $189,724 vs $261,314, P < .0001) CONCLUSION We identified an inverse relationship between national trends in increasing ET and diminishing DC utilization for stroke treatment over a recent decade. Although direct causation cannot be inferred, our findings suggest that ET curtails the necessity for DC.

Endovascular treatment of ischaemic stroke patients - new evidence and old challenges

VASA ◽  
2016 ◽  
Vol 45 (4) ◽  
pp. 267-274 ◽  
Author(s):  
Johannes Gerber ◽  
Volker Puetz ◽  
Ulf Bodechtel ◽  
Hagen Kitzler ◽  
Ruediger von Kummer ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Endovascular Treatment ◽  
Standard Of Care ◽  
Interdisciplinary Cooperation ◽  
Evidence Based ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Stroke Treatment ◽  
New Evidence

Abstract. An overwhelming benefit from endovascular treatment of ischaemic stroke could be shown in recent clinical trials, making it the new evidence-based standard of care for ischaemic stroke due to large vessel occlusion. To provide all eligible stroke patients with this therapy at any time, stroke networks and hospitals should streamline their workflow to rapidly image, select, and treat stroke patients. Interdisciplinary cooperation is vital for effective emergency endovascular stroke treatment, which is one of the most complex multidisciplinary functions a hospital can undertake.

Abstract WP19: Transfer Selection for Endovascular Therapy of Ischemic Stroke within A Collaborative Network: Off-site Versus On-site Neurology Service

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Simon M Winzer ◽  
Kristian Barlinn ◽  
Johannes Gerber ◽  
Timo Siepmann ◽  
Lars-Peder Pallesen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Functional Outcome ◽  
Endovascular Therapy ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Comprehensive Stroke Center ◽  
Favorable Functional Outcome ◽  
Selection Of Patients ◽  
Selection Of

Introduction: Selection of patients for endovascular therapy (EVT) may depend on the hospital providing first line assessment. In our collaborative stroke network, we aimed to compare clinical characteristics and outcomes in ischemic stroke patients undergoing EVT who were transferred from telestroke hospitals following teleconsultation and in those transferred from hospitals providing on-site neurology service. Methods: We analyzed prospectively collected data from consecutive ischemic stroke patients who underwent emergent EVT at our comprehensive stroke center (01/2010 to 12/2014) after acute transfer from either telestroke hospitals or non-telestroke hospitals with on-site neurology service. We compared baseline characteristics, onset-to-EVT time, symptomatic intracranial hemorrhage (sICH), favorable functional outcome (mRS 0-2) at discharge and in-hospital mortality. Results: Among 133 transferred patients who underwent emergent EVT: median age 67 years (IQR, 15); 56% men; median NIHSS score 17 (21); 52% had anterior and 48% posterior circulation stroke. Sixty-five patients (49%) were transferred from telestroke and 68 (51%) from non-telestroke hospitals. Telestroke patients were less severely affected (median NIHSS scores: 15 [7] vs. 22 [20]; p=.0005) and more likely to have anterior circulation stroke (69% vs. 35%; p<.0001) compared with non-telestroke patients. No between-group differences were present with regard to demographics, vascular risk factors, intravenous tPA rate and onset-to-EVT time. In-hospital mortality was lower among telestroke compared with non-telestroke patients (11% vs. 26%; p=.026). There were no differences in sICH (5% vs. 4%; p=1.0) and favorable functional outcome (17% vs. 18%; p=1.0). Conclusions: Patients transferred from telestroke hospitals were twice as often treated for anterior circulation stroke than those from non-telestroke neurological hospitals within our stroke network. This might be explained by more conservative selection of patients potentially amenable for EVT in hospitals harboring on-site neurology service but no EVT-capability. As our data was acquired prior to evidence from the positive EVT trials, further research is warranted to elaborate these findings.

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