Current knowledge of large vascular occlusion due to intracranial atherosclerosis: focusing on early diagnosis

Liu, Peng; Liu, Pei; Hua, Weilong; Yang, Wenjin; Zhang, Yongxin; Zhang, Lei; Xing, Pengfei; Li, Zifu; Zhang, Yong‐Wei; Hong, Bo; Yang, Pengfei; Liu, Jianmin

doi:10.1186/s41016-020-00213-1

Cited by 8 publications

(5 citation statements)

References 74 publications

(94 reference statements)

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“…Knowing the occlusion type is important, as large-vessel occlusion due to intracranial atherosclerotic disease requires specific endovascular modalities to achieve successful recanalization 70 as well as appropriate secondary stroke prevention. Findings suggestive of large-vessel occlusion due to intracranial atherosclerotic disease include residual stenosis after thrombectomy, truncal-type occlusion (an arterial occlusion found at the middle of an artery with visible distal major branches and bifurcation site beyond occlusion), robust collateral circulation, and microcatheter first-pass effect (blood flow through the occlusion after the withdrawal of the microcatheter) 71 . DSA also provides valuable information about the collateral circulation that is important to maintain perfusion downstream from arterial occlusions and determine the pace of infarct evolution 72 .…”

Section: Digital Subtraction Angiographymentioning

confidence: 99%

“…Findings suggestive of large-vessel occlusion due to intracranial atherosclerotic disease include residual stenosis after thrombectomy, truncal-type occlusion (an arterial occlusion found at the middle of an artery with visible distal major branches and bifurcation site beyond occlusion), robust collateral circulation, and microcatheter first-pass effect (blood flow through the occlusion after the withdrawal of the microcatheter). 71 DSA also provides valuable information about the collateral circulation that is important to maintain perfusion downstream from arterial occlusions and determine the pace of infarct evolution. 72 In tandem occlusions or in the setting of a nonopacified carotid artery on CTA, DSA can accurately distinguish true cervical internal carotid artery occlusion from pseudo-occlusion secondary to distal thrombosis that impedes ascending blood flow.…”

Section: Limitations Of Mri In Acute Strokementioning

confidence: 99%

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Imaging of Central Nervous System Ischemia

Shulman¹,

Abdalkader²

2023

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVE: This article describes imaging modalities used in the evaluation of patients presenting with symptoms of acute ischemic stroke.LATEST DEVELOPMENTS: The year 2015 marked the beginning of a new era in acute stroke care with the widespread adoption of mechanical thrombectomy. Subsequent randomized controlled trials in 2017 and 2018 brought the stroke community even further into this new territory with the expansion of the eligibility window for thrombectomy using imaging-based patient selection, which led to an increase in the use of perfusion imaging. Now, after several years of routine use, the debate is ongoing as to when this additional imaging is truly required and when it results in unnecessary delays in time-sensitive stroke care. At this time, more than ever, a robust understanding of neuroimaging techniques, applications, and interpretation is essential for the practicing neurologist.ESSENTIAL POINTS: CT-based imaging is the first step in most centers for the evaluation of patients presenting with symptoms of acute stroke because of its wide availability, speed, and safety. Noncontrast head CT alone is sufficient for IV thrombolysis decision making. CT angiography is very sensitive for the detection of large-vessel occlusion and can be used reliably to make this determination. Advanced imaging including multiphase CT angiography, CT perfusion, MRI, and MR perfusion can provide additional information useful for therapeutic decision making in specific clinical scenarios. In all cases, it is essential that neuroimaging be performed and interpreted rapidly to allow for timely reperfusion therapy.

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Section: Digital Subtraction Angiographymentioning

confidence: 99%

Section: Limitations Of Mri In Acute Strokementioning

confidence: 99%

Imaging of Central Nervous System Ischemia

Shulman¹,

Abdalkader²

2023

CONTINUUM: Lifelong Learning in Neurology

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“…The most common strategy to verify the diagnosis of ICAS-LVO is based on the existence of remaining atherosclerotic stenosis on digital subtractive angiography (DSA) imaging during the procedure ( 9 ). However, the endovascular diagnosis of ICAS-LVO requires time, which might undermine the efficiency of the recanalization procedure.…”

Section: Introductionmentioning

confidence: 99%

Early diagnosis of intracranial atherosclerotic large vascular occlusion: A prediction model based on DIRECT-MT data

Zhang

et al. 2022

Front. Neurol.

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AimsThis study aimed to build a prediction model to early diagnose intracranial atherosclerosis (ICAS)-related large vascular occlusion (LVO) in acute ischemic stroke patients before digital subtractive angiography.MethodsPatients enrolled in the DIRECT-MT trial (NCT03469206) were included in our secondary analysis and distributed into ICAS-LVO and non-ICAS-LVO groups. We also retrieved demographic data, medical histories, clinical characteristics, and pre-operative imaging data. Hypothesis testing was used to compare data of the two groups, and univariate logistic regression was used to identify the predictors of ICAS-LVO primarily. Then, we used multivariate logistic regression to determine the independent predictors and formulate the prediction model. Model efficacy was estimated by the area under the receiver operating characteristic (ROC) curve (AUC) and diagnostic parameters generated from internal and external validations.ResultsThe subgroup analysis included 45 cases in the ICAS-LVO group and 611 cases in the non-ICAS-LVO group. Variates with p < 0.1 in the comparative analysis were used as inputs in the univariate logistic regression. Next, variates with p < 0.1 in the univariate logistic regression were used as inputs in the multivariate logistic regression. The multivariate logistic regression indicated that the atrial fibrillation history, hypertension and smoking, occlusion located at the proximal M1 and M2, hyperdense artery sign, and clot burden score were related to the diagnosis of ICAS-LVO. Then, we constructed a prediction model based on multivariate logistics regression. The sensitivity and specificity of the model were 84.09 and 74.54% in internal validation and 73.11 and 71.53% in external validation.ConclusionOur current prediction model based on clinical data of patients from the DIRECT-MT trial might be a promising tool for predicting ICAS-LVO.

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“…Recognizing the difference between ICAS-LVO and embolism-LVO (EMB-LVO) before EVT is critical. Studies from Korea, 15 China, 16 and the United States 17 have focused on pinpointing clinical and imaging features that distinguish the two etiologies. Considered parameters have encompassed demographics, medical histories, and clinical manifestations, including both symptoms and physical examination findings.…”

mentioning

confidence: 99%

“…Clinicians may grapple with filtering vital information from a sea of feedback. 16 Therefore, our goal was to use a random forest algorithm for feature filtering and the prediction of ICAS-LVO, focusing on feature significance and objectivity. Given the high occurrence of anterior circulation LVO and the evidence supporting the EVT approach combined with intravenous tirofiban administration for ICAS-LVO within the anterior circulation, our objective was to develop and validate a novel predictive model score for anterior circulation ICAS-LVO before EVT.…”

mentioning

confidence: 99%

Development and internal-external validation of the ATHE Scale: predicting acute large vessel occlusion due to underlying intracranial atherosclerosis prior to endovascular treatment

Chen,

Liu,

Yang

et al. 2024

Journal of Neurosurgery

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OBJECTIVE The diagnosis of intracranial atherosclerosis (ICAS) associated with large vessel occlusion (LVO) before endovascular treatment (EVT) remains a clinical challenge. This study was aimed at developing a predictive model for ICAS-LVO in the anterior circulation preceding EVT. METHODS Patients from two national stroke centers who had undergone EVT for acute ischemic stroke in the anterior circulation were evaluated. Those from one center served as the derivation cohort, whereas patients from another center functioned as the external validation cohort. ICAS-LVO was characterized as stenosis exceeding 70% or stenosis surpassing 50% accompanied by distal blood flow disruption or recurrent occlusion evidence during the intervention. A random forest algorithm helped to identify key predictors within the derivation cohort. Utilizing these predictors, the authors formulated a logistic regression model from the derivation cohort data, and the model was then internally validated through a bootstrapping method. Subsequently, a predictive score based on this model was constructed and evaluated in both cohorts. RESULTS Among all the patients, 470 from the derivation cohort and 147 from the external validation cohort met the inclusion criteria. After random forest regression, the key predictors of ICAS-LVO included the absence of atrial fibrillation, the presence of truncal-type occlusion, the absence of a hyperdense artery sign, and a lower baseline examination National Institutes of Health Stroke Scale (NIHSS) score (ATHE Scale). Incorporating these variables into the logistic regression model yielded an area under the curve (AUC) of 0.920 (95% CI 0.894–0.947) for ICAS-LVO prediction. After bootstrapping validation, the model produced a mean AUC of 0.915. Subsequently, the ATHE score, derived from these predictors, registered an AUC of 0.916 (95% CI 0.887–0.939, p < 0.001) in the derivation cohort and 0.890 (95% CI 0.828–0.936, p < 0.001) in the external validation cohort. CONCLUSIONS The ATHE Scale, incorporating atrial fibrillation, truncal-type occlusion, hyperdense artery sign, and baseline examination NIHSS score, is an accurate, objective tool for predicting ICAS-LVO prior to EVT.

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Current knowledge of large vascular occlusion due to intracranial atherosclerosis: focusing on early diagnosis

Cited by 8 publications

References 74 publications

Imaging of Central Nervous System Ischemia

Imaging of Central Nervous System Ischemia

Early diagnosis of intracranial atherosclerotic large vascular occlusion: A prediction model based on DIRECT-MT data

Development and internal-external validation of the ATHE Scale: predicting acute large vessel occlusion due to underlying intracranial atherosclerosis prior to endovascular treatment

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