ColorViz, a New and Rapid Tool for Assessing Collateral Circulation during Stroke

Verdolotti, Tommaso; Pilato, Fabio; Cottonaro, Simone; Monelli, Edoardo; Giordano, Carolina; Guadalupi, Pamela; Benenati, Massimo; Ramaglia, Antonia; Costantini, Alessandro; Alexandre, Andrea; Iorio, Riccardo Di; Colosimo, Cesare

doi:10.3390/brainsci10110882

Cited by 26 publications

(16 citation statements)

References 15 publications

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“…Our method for the segmentation of the thrombus using the contralateral parenchyma HU values to determine the optimal threshold that discriminates thrombus, and then using a volume growing approach to generate the 3D thrombus model, is simple and quick, and therefore more practical in the clinical setting. Our 3D models can potentially be used in conjunction with other tools in acute stroke imaging such as multiphase CTA color-maps and ColorViz for assessing collateral circulation [13,14].…”

Section: Discussionmentioning

confidence: 99%

Identifying Thrombus on Non-Contrast CT in Patients with Acute Ischemic Stroke

Qazi

Wilson

et al. 2021

Diagnostics

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The hyperdense sign is a marker of thrombus in non-contrast computed tomography (NCCT) datasets. The aim of this work was to determine optimal Hounsfield unit (HU) thresholds for thrombus segmentation in thin-slice non-contrast CT (NCCT) and use these thresholds to generate 3D thrombus models. Patients with thin-slice baseline NCCT (≤2.5 mm) and MCA-M1 occlusions were included. CTA was registered to NCCT, and three regions of interest (ROIs) were placed in the NCCT, including: the thrombus, contralateral brain tissue, and contralateral patent MCA-M1 artery. Optimal HU thresholds differentiating the thrombus from non-thrombus tissue voxels were calculated using receiver operating characteristic analysis. Linear regression analysis was used to predict the optimal HU threshold for discriminating the clot only based on the average contralateral vessel HU or contralateral parenchyma HU. Three-dimensional models from 70 participants using standard (45 HU) and patient-specific thresholds were generated and compared to CTA clot characteristics. The optimal HU threshold discriminating thrombus in NCCT from other structures varied with a median of 51 (IQR: 49–55). Experts chose 3D models derived using patient-specific HU models as corresponding better to the thrombus seen in CTA in 83.8% (31/37) of cases. Patient-specific HU thresholds for segmenting the thrombus in NCCT can be derived using normal parenchyma. Thrombus segmentation using patient-specific HU thresholds is superior to conventional 45 HU thresholds.

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Section: Discussionmentioning

confidence: 99%

Identifying Thrombus on Non-Contrast CT in Patients with Acute Ischemic Stroke

Qazi

Wilson

et al. 2021

Diagnostics

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“…The use of multiphase CT angiography allows for better localization of arterial occlusion and provides a spatial and temporal evaluation of the patency and status of the collateral circulation. Usage of the summated time variant color-code map (ColorViz) allows an even more immediate and clearer visual impact, and avoids the need to compare three different phases at the same time, thus resulting in faster and more understandable diagnostic evaluation for stroke clinicians [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Mechanical Thrombectomy using Penumbra ACETM Aspiration Catheter Compared to Stent Retriever SolitaireTM FR in Patients with Acute Ischemic Stroke

et al. 2021

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Background: Mechanical thrombectomy is the standard therapy in patients with acute ischemic stroke (AIS). The primary aim of our study was to compare the procedural efficacy of the direct aspiration technique, using Penumbra ACETM aspiration catheter, and the stent retriever technique, with a SolitaireTM FR stent. Secondarily, we investigated treatment-dependent and treatment-independent factors that predict a good clinical outcome. Methods: We analyzed our series of mechanical thrombectomies using a SolitaireTM FR stent and a Penumbra ACETM catheter. The clinical and radiographic data of 76 patients were retrospectively reviewed. Using binary logistic regression, we looked for the predictors of a good clinical outcome. Results: In the Penumbra ACETM group we achieved significantly higher rates of complete vessel recanalization with lower device passage counts, shorter recanalization times, shorter procedure times and shorter fluoroscopy times (p < 0.001) compared to the SolitaireTM FR group. We observed no significant difference in good clinical outcomes (52.4% vs. 56.4%, p = 0.756). Predictors of a good clinical outcome were lower initial NIHSS scores, pial arterial collateralization on admission head CT angiography scan, shorter recanalization times and device passage counts. Conclusions: The aspiration technique using Penumbra ACETM catheter is comparable to the stent retriever technique with SolitaireTM FR regarding clinical outcomes.

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“…Given that the persistence of a minimal neurological impairment in patients with LVO is due to the recruitment of efficient leptomeningeal collaterals, these patients may also benefit from a prolonged time window for MT [11,12,17,19,26,27,33] as they can maintain a small ischemic core and a significant amount of salvageable brain tissue beyond 6 hours from onset (the so-called "slow progressors") [34,35]. Indeed, in our series, 9 out of 17 patients (53%) were treated beyond the initial 6 hours from onset.…”

Section: Discussionmentioning

confidence: 99%

Mechanical thrombectomy in patients with stroke due to large vessel occlusion in the anterior circulation and low scale score

Alexandre

Valente

Frisullo

et al. 2021

Journal of Integrative Neuroscience

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We sought to verify the benefit of mechanical thrombectomy in patients with acute ischemic stroke due to large vessel occlusion in the anterior circulation and low National Institute of Health stroke scale score at presentation. The prospective database of our stroke center was screened for patients with acute ischemic stroke due to large vessel occlusion and a baseline National Institute of Health stroke scale score ≤5 that had undergone mechanical thrombectomy. Outcome measures were the modified Rankin Scale (mRS) score at 90 days, brain bleeding events and death at 90 days. Out of 459 patients, 17 (12 females, mean age 70 ± 14 years) with occlusion of M1 or M2 segment of middle cerebral artery and baseline National Institute of Health stroke scale score ≤5 underwent mechanical thrombectomy. Eight patients (47%) were treated within 6 hours from the onset, 5 (29%) were treated beyond 6 hours, and 4 (24%) were wakeup strokes. Effective mechanical thrombectomy was achieved in 16 patients (94%) and associated with excellent functional outcomes at 3 months (mRS 0-1) in 13 (76%). The asymptomatic brain-bleeding event was observed in one patient 4 days after effective mechanical thrombectomy concerning safety issues. One patient died 1 month after mechanical thrombectomy of a cause unrelated to stroke. Our findings favor a potential benefit of mechanical thrombectomy in patients with stroke due to large vessel occlusion and low National Institute of Health stroke scale score at presentation. These patients may also benefit from a prolonged time window for treatment.

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ColorViz, a New and Rapid Tool for Assessing Collateral Circulation during Stroke

Cited by 26 publications

References 15 publications

Identifying Thrombus on Non-Contrast CT in Patients with Acute Ischemic Stroke

Identifying Thrombus on Non-Contrast CT in Patients with Acute Ischemic Stroke

Efficacy of Mechanical Thrombectomy using Penumbra ACETM Aspiration Catheter Compared to Stent Retriever SolitaireTM FR in Patients with Acute Ischemic Stroke

Mechanical thrombectomy in patients with stroke due to large vessel occlusion in the anterior circulation and low scale score

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