scholarly journals LEPTOMENINGEAL COLLATERAL SUPPLY IN ISCHEMIC STROKE PATIENTS: A COMPARISON OF SINGLE-PHASE CT-ANGIOGRAPHY, MULTIPHASE CT-ANGIOGRAPHY, CT-PERFUSION AND DIGITAL SUBTRACTION ANGIOGRAPHY

2019 ◽  
Author(s):  
Frans Kauw ◽  
Jan W. Dankbaar ◽  
Blake W. Martin ◽  
Victoria Ding ◽  
Derek B. Boothroyd ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Digital Subtraction Angiography ◽  
Ct Angiography ◽  
Single Phase ◽  
Ct Perfusion ◽  
Digital Subtraction ◽  
Stroke Patients ◽  
Multiphase Ct

scholarly journals Dynamic CT but Not Optimized Multiphase CT Angiography Accurately Identifies CT Perfusion Target Mismatch Ischemic Stroke Patients

2019 ◽  
Vol 10 ◽  
Author(s):  
Huiqiao Tian ◽  
Chushuang Chen ◽  
Carlos Garcia-Esperon ◽  
Mark W. Parsons ◽  
Longting Lin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Ct Angiography ◽  
Ct Perfusion ◽  
Dynamic Ct ◽  
Stroke Patients ◽  
Multiphase Ct

scholarly journals Assessing the Relative Value of CT Perfusion Compared to Non-contrast CT and CT Angiography in Prognosticating Reperfusion-Eligible Acute Ischemic Stroke Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Andrew Bivard ◽  
Christopher Levi ◽  
Longting Lin ◽  
Xin Cheng ◽  
Richard Aviv ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Ct Angiography ◽  
Predictive Accuracy ◽  
Ct Perfusion ◽  
Imaging Modality ◽  
Characteristic Curve ◽  
Treatment Decision ◽  
Receiver Operator Characteristic Curve ◽  
Stroke Patients

In the present study we sought to measure the relative statistical value of various multimodal CT protocols at identifying treatment responsiveness in patients being considered for thrombolysis. We used a prospectively collected cohort of acute ischemic stroke patients being assessed for IV-alteplase, who had CT-perfusion (CTP) and CT-angiography (CTA) before a treatment decision. Linear regression and receiver operator characteristic curve analysis were performed to measure the prognostic value of models incorporating each imaging modality. One thousand five hundred and sixty-two sub-4.5 h ischemic stroke patients were included in this study. A model including clinical variables, alteplase treatment, and NCCT ASPECTS was weak (R2 0.067, P < 0.001, AUC 0.605) at predicting 90 day mRS. A second model, including dynamic CTA variables (collateral grade, occlusion severity) showed better predictive accuracy for patient outcome (R2 0.381, P < 0.001, AUC 0.781). A third model incorporating CTP variables showed very high predictive accuracy (R2 0.488, P < 0.001, AUC 0.899). Combining all three imaging modalities variables also showed good predictive accuracy for outcome but did not improve on the CTP model (R2 0.439, P < 0.001, AUC 0.825). CT perfusion predicts patient outcomes from alteplase therapy more accurately than models incorporating NCCT and/or CT angiography. This data has implications for artificial intelligence or machine learning models.

scholarly journals Prognosis of ischemic stroke patients with or without collateralization after carotid stenosis

2018 ◽  
Vol 11 (4) ◽  
pp. 270-273
Author(s):  
Subash Kanti Dey ◽  
Md. Shahidullah ◽  
Anis Ahmed ◽  
Ahsan Habib ◽  
Abu Nasar Rizvi
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Carotid Stenosis ◽  
Digital Subtraction Angiography ◽  
P Value ◽  
Digital Subtraction ◽  
Stroke Patients

The objective of this study was to see the  association of the prognosis of ischemic stroke patients with or without collateralization after carotid stenosis. This study was conducted on 36 patients presenting with acute ischemic stroke who were going through digital subtraction angiography from March 2017 to March 2018. Collateralization status after unilateral or bilateral stenosis was evaluated. Modified ranking scale (mRS) score was  measured on the first day of the stroke and after three months. The disability of ischemic stroke patients was compared between patients who developed collateralization and who had not. Among them, 61.6% developed collateralization. Among the patients who developed collateralization after three months, 90.9% patients had mRS scale of ≤2 and who not developed collateralization, 85.7% patients had mRS scale of ≤2. In both the groups, the p value was <0.05. It can be concluded that carotid stenosed patients who suffered from ischemic stroke, most of the patients disability improved to some extents whether collateralization developed or not among the major vessels.

Abstract 1122‐000034: Systematic CT‐Perfusion acquisition in All Suspected Stroke Patients Increases Vascular Occlusion Detection and Thrombectomy Rates

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Marta Olive‐Gadea ◽  
Manuel Requena ◽  
Facundo Diaz ◽  
Alvaro Garcia‐Tornel ◽  
Marta Rubiera ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Symptoms ◽  
Ct Perfusion ◽  
False Negative ◽  
False Negative Rate ◽  
Vascular Occlusion ◽  
Stroke Patients ◽  
Imaging Protocols ◽  
The Impact

Introduction : In acute ischemic stroke patients, current guidelines recommend noninvasive vascular imaging to identify intracranial vessel occlusions (VO) that may benefit from endovascular treatment (EVT). However, VO can be missed in CT angiography (CTA) readings. We aim to evaluate the impact of consistently including CT perfusion (CTP) in admission stroke imaging protocols on VO diagnosis and EVT rates. Methods : We included patients with a suspected acute ischemic stroke that underwent urgent non‐contrast CT, CTA and CTP from April to October 2020. Hypoperfusion areas defined by Tmax>6s delay (RAPID software), congruent with the clinical symptoms and a vascular territory, were considered due to a VO (CTP‐VO). Cases in which mechanical thrombectomy was performed were defined as therapeutically relevant VO (EVT‐VO). For patients that received EVT, site of VO according to digital subtraction angiography was recorded. Two experienced neuroradiologists blinded to CTP but not to clinical symptoms, retrospectively evaluated NCCT and CTA to identify intracranial VO (CTA‐VO). We analyzed CTA‐VO sensitivity and specificity at detecting CTP‐VO and EVT‐VO respecitvely. We performed a logistic regression to test the association of Tmax>6s volumes with CTA‐VO identification and indication of EVT. Results : Of the 338 patients included in the analysis, 157 (46.5%) presented a CTP‐VO, (median Tmax>6s: 73 [29‐127] ml). CTA‐VO was identified in 83 (24.5%) of the cases. Overall CTA‐VO sensitivity for the detection of CTP‐VO was 50.3% and specificity was 97.8%. Higher hypoperfusion volume was associated with an increased CTA‐VO detection, with an odds ratio of 1.03 (95% confidence interval 1.02‐1.04) (figure). DSA was indicated in 107 patients; in 4 of them no EVT was attempted due to recanalization or a too distal VO in the first angiographic run. EVT was performed in 103 patients (30.5%. Tmax>6s: 102 [63‐160] ml), representing 65.6% of all CTP‐VO. Overall CTA‐VO sensitivity for the detection of EVT‐VO was 69.9%. The CTA‐VO sensitivity for detecting patients with indication of EVT according to clinical guidelines was as follows: 91.7% for ICA occlusions and 84.4% for M1‐MCA occlusions. For all other occlusion sites that received EVT, the CTA‐VO sensitivity was 36.1%. The overall specificity was 95.3%. Among patients who received EVT, CTA‐VO was not detected in 31 cases, resulting in a false negative rate of 30.1%. False negative CTA‐VO cases had lower Tmax>6s volumes (69[46‐99.5] vs 126[84‐169.5]ml, p<0.001) and lower NIHSS (13[8.5‐16] vs 17[14‐21], p<0.001). Conclusions : Systematically including CTP perfusion in the acute stroke admission imaging protocols may increase the diagnosis of VO and rate of EVT.

Comparison Between Computed Tomography Angiography and Digital Subtraction Angiography in Critical Lower Limb Ischemia

2019 ◽  
Vol 15 (5) ◽  
pp. 496-503 ◽  
Author(s):  
Hesham Ebrahim Ahmed Al-rudaini ◽  
Ping Han ◽  
Huimin Liang
Keyword(s):  
Digital Subtraction Angiography ◽  
Ct Angiography ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Definitive Treatment ◽  
Digital Subtraction ◽  
Arterial Tree ◽  
Lower Limb Ischemia ◽  
Significant Difference ◽  
Peripheral Arterial

Background:CT Angiography (CTA) of aortoiliac and lower extremity arteries is a relatively recent innovation of CT imaging that has changed after the introduction of multi-detector row scanners.Objective:The study aimed to evaluate the diagnostic accuracy of Multidetector Computed Tomographic Angiography (MDCTA) in the assessment of arterial tree in patients with Peripheral Arterial Occlusive Disease (PAOD), as compared to Digital Subtraction Angiography (DSA).Methods:A single-center nonrandomized prospective study was conducted on 50 patients complaining of peripheral arterial disease (chronic stage) from February 2017 to October 2017. All the patients were exposed to DSA and CTA prior to definitive treatment. The images were then analyzed using maximum intensity projection, volume-rendered, and curved multiplane reformation techniques.Results:All the patients involved in this study were susceptible according to their clinical presentation. The statistical analysis exposed a highly significant difference between CTA and DSA in the assessment of stenosis at the level of Femoropopliteal segment (P<0.01), while for infrapopliteal segment, there was no statistically significant difference between CTA and DSA having 8% versus 14% insignificant stenosis and 62% versus 47% significant stenosis in CTA and DSA, respectively. The overall accuracy of CT angiography in the femoropopliteal segments was 95.20% while in the infrapopliteal segment it was 94.5%.Conclusion:Multidetector CT angiography was found to be a reliable alternative mean for pathoanatomical description of the arterial lesions in critical lower limb ischemia and its subsequent management in comparison to digital subtraction angiography.

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