scholarly journals Fast Automatic Detection of Large Vessel Occlusions on CT Angiography

Stroke ◽  
2019 ◽  
Vol 50 (12) ◽  
pp. 3431-3438 ◽  
Author(s):  
Shalini A. Amukotuwa ◽  
Matus Straka ◽  
Seena Dehkharghani ◽  
Roland Bammer
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Diagnostic Performance ◽  
Internal Carotid ◽  
Roc Curves ◽  
Interquartile Range ◽  
Large Vessel ◽  
Therapeutic Window ◽  
Anterior Circulation ◽  
Vessel Occlusion

Background and Purpose— Accurate and rapid detection of anterior circulation large vessel occlusion (LVO) is of paramount importance in patients with acute stroke due to the potentially rapid infarction of at-risk tissue and the limited therapeutic window for endovascular clot retrieval. Hence, the optimal threshold of a new, fully automated software-based approach for LVO detection was determined, and its diagnostic performance evaluated in a large cohort study. Methods— For this retrospective study, data were pooled from: 2 stroke trials, DEFUSE 2 (n=62; 07/08–09/11) and DEFUSE 3 (n=213; 05/17–05/18); a cohort of endovascular clot retrieval candidates (n=82; August 2, 2014–August 30, 2015) and normals (n=111; June 6, 2017–January 28, 2019) from a single quaternary center; and code stroke patients (n=501; January 1, 2017–December 31, 2018) from a single regional hospital. All CTAs were assessed by the automated algorithm. Consensus reads by 2 neuroradiologists served as the reference standard. ROC analysis was used to assess diagnostic performance of the algorithm for detection of (1) anterior circulation LVOs involving the intracranial internal carotid artery or M1 segment middle cerebral artery (M1-MCA); (2) anterior circulation LVOs and proximal M2 segment MCA (M2-MCA) occlusions; and (3) individual segment occlusions. Results— CTAs from 926 patients (median age 70 years, interquartile range: 58-80; 422 females) were analyzed. Three hundred ninety-five patients had an anterior circulation LVO or M2-MCA occlusion (National Institutes of Health Stroke Scale 14 [median], interquartile range: 9–19). Sensitivity and specificity were 97% and 74%, respectively, for LVO detection, and 95% and 79%, respectively, when M2 occlusions were included. On analysis by occlusion site, sensitivities were 90% (M2-MCA), 97% (M1-MCA), and 97% (intracranial internal carotid artery) with corresponding area-under-the-ROC-curves of 0.874 (M2), 0.962 (M1), and 0.997 (intracranial internal carotid artery). Conclusions— Intracranial anterior circulation LVOs and proximal M2 occlusions can be rapidly and reliably detected by an automated detection tool, which may facilitate intra- and inter-instutional workflows and emergent imaging triage in the care of patients with stroke.

Abstract WP20: Efficacy and Safety of Mechanical Thrombectomy in Emergent Large Vessel Occlusions with Concomitant Cervical Internal Carotid Artery Occlusion

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Nitin Goyal ◽  
Georgios Tsivgoulis ◽  
Abhi Pandhi ◽  
Yasser M Khorchid ◽  
Abhishek Ojha ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Efficacy And Safety ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Aspiration Thrombectomy ◽  
Cervical Internal Carotid Artery

Introduction: Recently, five published major randomized controlled clinical trials have demonstrated that timely mechanical thrombectomy (MT) of acute ischemic strokes (AIS) with emergent large vessel occlusion (ELVO) is safe and improves functional outcomes. However, data evaluating the efficacy and safety of MT in ELVO patients with concomitant cervical internal carotid artery (cICA) occlusion is limited. The purpose of this study is to evaluate efficacy and safety of MT in ELVO patients with concomitant cICA occlusion Methods: We prospectively analyzed consecutive AIS patients with anterior circulation ELVO who underwent stent-retriever or primary aspiration thrombectomy at two tertiary stroke centers. Outcome measures in our study were 3-month mortality and modified ranking scale (mRS), as well as symptomatic intracranial hemorrhage (sICH). Safety and efficacy outcomes were compared between ELVO patients with and without concomitant cICA occlusion. Results: A total of 137 AIS patients had anterior circulation ELVO and underwent MT (age 63 ± 14, 49% male, median NIHSS 17, IQR [13-20]). ELVO patients with concomitant cICA occlusion (n=19) did not differ in terms of rates of sICH (0% versus 11%, p=0.21), complete recanalization (68 % versus 68%, p=1.00), onset to groin puncture time (minutes [IQR] 268 [211-379] versus 225 [165-312], p=0.47), 3-month mortality (35% versus 26 %, p=0.55), and mRS of 0-2 at 3 months (41% versus 45%, p=0.80) when compared with ELVO patients without concomitant cICA occlusion (n=118). Admission NIHSS was higher among ELVO patients with concomitant cICA occlusion (median [IQR], 18 [15-22] versus 16 [12-19], p=0.01), and they tended to have higher groin puncture to recanalization time (minutes [IQR] 74 [42-97] versus 49 [38-78], p=0.09). The ordinal shift analysis did not show any difference in favorable outcomes in two groups in unadjusted analyses or after adjustment for admission NIHSS and groin to recanalization time (common OR=0.78 [95% CI: 0.27-2.29, p=0.66]). Angioplasty was performed in 11 of 19 ELVO patients with concomitant cICA occlusion. Three patients required stent placement. Discussion: Our study indicates that MT can be performed safely and effectively in ELVO patients with concomitant cICA occlusion.

scholarly journals Thrombectomy by primary aspiration technique in a patient with critical internal carotid artery stenosis

2021 ◽  
Author(s):  
Yasmim Nadime José Frigo ◽  
Hendrick Henrique Fernandes Gramasco ◽  
Igor Oliveira Fonseca ◽  
Mateus Felipe dos Santos ◽  
Rodrigo Bazan ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Neurological Deficits ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Clinical Prognosis ◽  
Aspiration Technique

Context: Stroke is one of the main leaders of death and disability in the world. Currently, mechanical thrombectomy with stent retrievers is the technique of choice for large vessel occlusion, however, the primary aspiration technique has been proposed as a fast and safe alternative. Case report: J.E.M, male, 57 years old, hypertensive, atrial fibrillation. Started claudication of neurological deficits, with intermittent paresthesia in left upper limb for 2 days. Admitted with NIHSS 2 (nasolabial sulcus erasure and hypoesthesia in LUL), in thrombolysis window, has seen in cerebral and neck angiotomography critical stenosis of the internal carotid artery and in CT scan with perfusion Mismatch volume 72 ml and infinite ratio. Since the patient did not have sufficient criteria for thrombolysis and since the clinical prognosis was unfavorable, a diagnostic arteriography was indicated, which showed ICAR stenosis 90%. The patient proceeded with angioplasty and stenting using the ADPAT technique and mechanical thrombectomy due to occlusion in segment M1 with total recanalization (TICI 3) and NIHSS after and at discharge of 0. Conclusion: The advent of thrombectomy impacts the improvement of functional dependence and the reduction of mortality, especially in stroke with large vessel occlusion, whose treatment with thrombolytic therapy only has a low chance of recanalization.

scholarly journals Cervical internal carotid artery tortuosity: A morphologic analysis of patients with acute ischemic stroke

2019 ◽  
Vol 26 (2) ◽  
pp. 216-221
Author(s):  
John C Benson ◽  
Waleed Brinjikji ◽  
Steven A Messina ◽  
Giuseppe Lanzino ◽  
David F Kallmes
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Internal Carotid ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Procedure Time ◽  
Vessel Occlusion ◽  
Cervical Internal Carotid Artery

Background and purpose Cervical internal carotid artery (ICA) tortuosity is thought to impede distal catheterization during attempted mechanical thrombectomy in patients with acute ischemic stroke. This study sought to assess the morphologic characteristics of ICAs and the effects of tortuosity on thrombectomy attempts. Methods A retrospective review was completed of neck CTAs of patients with acute ischemic stroke due to a large vessel occlusion that underwent attempted endovascular recanalization. Significant tortuosity of ICAs was defined as the presence of kink(s) (acute (<90°) angulation), loop(s) (C- or S-shaped curvature with 2+ areas of acute (<90°) angulation), or coil(s) (full 360° turn arterial bend). Findings were statistically compared to procedure time, successful recanalization rate, patient demographics, and co-morbidities. Results Of 120 included patients, 47 (39.2%) had some form of tortuosity of one or both ICAs. Twenty-eight patients (23.3%) had a kink of one or both ICAs; this was followed in frequency by loops (n = 20; 16.7%) and coils (n = 8; 6.7%). Kinks were associated with lower rates of successful recanalization (p = 0.02). The presence of any tortuosity (kinks, loops, or coils) was not associated with number of passes during thrombectomy (p = 0.88), successful recanalization (p = 0.11), or total procedure time (p = 0.22). No association was noted between the presence of tortuosity and age (p = 0.96) or prior or current tobacco use (p = 0.75 and p = 0.69, respectively). Conclusion Among patients referred for urgent revascularization for large vessel occlusion, approximately 40% exhibit some tortuosity. Kinks may portend lower likelihood of recanalization success, although tortuosity as a whole seems to have little effect on endovascular thrombectomy.

scholarly journals Management of Tandem Cervical Internal Carotid Artery Stenosis and Large Vessel Occlusion During Acute Stroke: A Single Institution's Initial Experience

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Nicolas W Villelli ◽  
Andrew DeNardo ◽  
John Scott ◽  
Daniel Sahlein ◽  
Troy D Payner ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Stroke ◽  
Carotid Stenosis ◽  
Internal Carotid ◽  
Treatment Algorithm ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Ica Stenosis

Abstract INTRODUCTION Thrombectomy for large vessel occlusion (LVO) has become a well-established treatment for acute stroke. Management of tandem internal carotid artery (ICA) stenosis in thrombectomy patients can be challenging, as no formal treatment algorithm exists for this unique pathology. We present a single institution's experience with the acute treatment of ICA stenosis during or after thrombectomy with either carotid artery stent (CAS) or carotid endarterectomy (CEA). METHODS A retrospective analysis was performed on all patients who underwent thrombectomy with tandem ICA stenosis at our institution. All demographic, stroke presentation, stroke treatment, cervical carotid stenosis treatment, and follow-up data were analyzed for these patients. RESULTS From 2015 to 2018, 31 patients with tandem ICA stenosis underwent thrombectomy for LVO. Of these patients, 26 had a CAS placed, 25 of which were done at time of thrombectomy, and 1 placed 5 d after thrombectomy. CAS patients were placed on antiplatelet therapy after stent placement. Of the 25 patients who had CAS placed at time of thrombectomy, 5 patients had a symptomatic ICH, 4 of which did not survive the hospitalization. Two additional CAS patients did not survive hospitalization. There were 5 patients who had a CEA performed during the same hospital stay, ranging from 1 to 10 d post-thrombectomy. Patients who underwent CEA had a smaller area of infarct and a shorter thrombectomy procedure time when compared to the CAS patients, and all CEA patients survived hospitalization, with good outcomes. CONCLUSION CAS placement for tandem ICA stenosis at time of thrombectomy may be less safe than previously published. Early, but not simultaneous, intervention on cervical ICA stenosis after thrombectomy allows for the assessment of infarct volume, patient recovery, and the presence of intracerebral hemorrhage, and thus provides the opportunity to appropriately select patients who would benefit from treatment of the carotid stenosis with either CAS or CEA.

scholarly journals Transcarotid Mechanical Thrombectomy for Embolic Intracranial Large Vessel Occlusion after Endovascular Deconstructice Embolization for Carotid Blowout Syndrome

2020 ◽  
Vol 15 (1) ◽  
pp. 37-43 ◽  
Author(s):  
Chi-Ju Lu ◽  
Yen-Heng Lin ◽  
Chung-Wei Lee
Keyword(s):  
Head And Neck Cancer ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Head And Neck ◽  
Neck Cancer ◽  
Internal Carotid ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Carotid Blowout Syndrome

Carotid blowout syndrome (CBS) is a fatal complication of head and neck cancer. Endovascular treatment, particularly deconstructive embolization, is effective for CBS, but it might result in thromboembolic events. We report the case of a 57-year-old man with underlying recurrent head and neck cancer who had CBS. The patient received endovascular embolization of the right internal, external, and common carotid arteries. Right internal carotid artery to middle cerebral artery embolic occlusion was noted immediately after the procedure, and left-sided weakness and facial palsy were found. Ipsilateral suprabulbar cervical internal carotid artery puncture was performed under fluoroscopic guidance, and rescue suction thrombectomy was successful. The patient had no significant neurological sequela. Transcarotid intraarterial thrombectomy is a reasonable method for managing postembolization large vessel occlusion, even in the neck, after irradiation.

scholarly journals CT perfusion based ASPECTS improves the diagnostic performance of early ischemic changes in large vessel occlusion

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tiegong Wang ◽  
Luguang Chen ◽  
Xianglan Jin ◽  
Yuan Yuan ◽  
Qianwen Zhang ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Diagnostic Performance ◽  
Ct Perfusion ◽  
Roc Curves ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Scoring Method ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Poor Outcomes

Abstract Background ASPECTS scoring method varies, but which one is most suitable for predicting the prognosis still unclear. We aimed to evaluate the diagnostic performance of Automated (Auto)-, noncontrast CT (NCCT)- and CT perfusion (CTP) -ASPECTS for early ischemic changes (EICs) in acute ischemic stroke patients with large vessel occlusion (LVO) and to explore which scoring method is most suitable for predicting the clinical outcome. Methods Eighty-one patients with anterior circulation LVO were retrospectively enrolled and grouped as having a good (0–2) or poor (3–6) clinical outcome using a 90-day modified Rankin Scale score. Clinical characteristics and perfusion parameters were compared between the patients with good and poor outcomes. Differences in scores obtained with the three scoring methods were assessed. Diagnosis performance and receiver operating characteristic (ROC) curves were used to evaluate the value of the three ordinal or dichotomized ASPECTS methods for predicting the clinical outcome. Results Sixty-three patients were finally included, with 36 (57.1%) patients having good clinical outcome. Significant differences were observed in the ordinal or dichotomized Auto-, NCCT- and CTP-ASPECTS between the patients with good and poor clinical outcomes (all p < 0.01). The areas under the curves (AUCs) of the ordinal and dichotomized CTP-ASPECTS were higher than that of the other two methods (all p < 0.01), but the AUCs of the Auto-ASPECTS was similar to that of the NCCT-ASPECTS (p > 0.05). Conclusions The CTP-ASPECTS is superior to the Auto- and NCCT-ASPECTS in detecting EICs in LVO. CTP-ASPECTS with a cutoff value of 6 is a good predictor of the clinical outcome at 90-day follow-up.

Abstract P519: Higher Number of Thrombectomy Passes Significantly Increases Risk of Mass Effect, Poor Functional Outcome, and Mortality

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Victor M Ringheanu ◽  
Laurie Preston ◽  
WONDWOSSEN G TEKLE ◽  
Amrou Sarraj ◽  
Ameer E Hassan
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Functional Outcome ◽  
Internal Carotid ◽  
Mass Effect ◽  
Artery Occlusion ◽  
Delayed Presentation ◽  
Vessel Occlusion ◽  
Presentation Time ◽  
Poor Outcomes

Background: Endovascular treatment (EVT) is a widely proven method to treat patients diagnosed with intracranial large vessel occlusion (LVO). Through this method of treatment, it has been hypothesized that a lower number of thrombectomy passes is an indicator of higher rates of modified Thrombolysis in Cerebral Infarction 2b-3 (mTICI) and favorable outcomes defined as modified Rankin Scale 0-2 (mRS). Methods: Through the utilization of a prospectively collected endovascular database between 2012-2020, variables such as demographics, co-morbid conditions, intracerebral hemorrhage, mass effect, mortality rate, and good/poor outcomes in regard to mTICI score and mRS assessment at discharge were examined. The outcomes between patients receiving EVT who were treated with < 3 thrombectomy passes or ≥ 3 passes were compared. Results: Out of 454 patients treated with mechanical thrombectomy of qualifying intracranial internal carotid artery or middle cerebral artery occlusion, site of occlusion (internal carotid artery, M1 and M2), a total of 372 (81.9%) were treated with < 3 thrombectomy passes (average age 70.34 ± 13.75 years, 46.0% women), and 82 (18.1%) were treated with ≥ 3 thrombectomy passes (average age 70.30 ± 13.72 years, 48.8% women). Significantly higher rates of mass effect (p=0.043), mRS score 3-6 (p=0.029), and mortality (p=0.025) were noted in patients treated with ≥ 3 thrombectomy passes. Further analysis revealed that patients presenting 6-24 hours from symptom onset had significantly lessened chance of effective recanalization (TICI 2B-3; p=0.021). Conclusion: A higher number of thrombectomy passes, characterized as ≥ 3 passes in this study, was associated with significantly worsened patient outcome in regard to functional outcome, and mortality. Further research is required to determine whether the number of thrombectomy passes is an accurate indicator of treatment outcome and whether delayed presentation time increases risk of poor outcome.

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