Evaluation of Collaterals and Clot Burden Using Time-Resolved C-Arm Conebeam CT Angiography in the Angiography Suite: A Feasibility Study

Yang, Pengfei; Niu, Kai; Wu, Yijing; Struffert, Tobias; Doerfler, Arnd; Hölter, Philip; Aagaard-Kienitz, B.; Strother, Charles M.; Chen, Guang‐Hong

doi:10.3174/ajnr.a5072

Cited by 11 publications

(5 citation statements)

References 18 publications

(25 reference statements)

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“…Concerning question 3 and 4, our study, together with findings from Yang et al (already demonstrating the feasibility of collateral status evaluation with FDCTA [ 23 ]), provides further evidence for the use of FDCTA in the one-stop management paradigm in acute ischemic stroke. We could demonstrate, that this method has equal predictive value compared to DSA derived collateral status evaluation.…”

Section: Discussionsupporting

confidence: 69%

Validation of collateral scoring on flat-detector multiphase CT angiography in patients with acute ischemic stroke

Maier

Scalzo²,

Leyhe

et al. 2018

PLoS ONE

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BackgroundThe pivotal impact of collateral circulation on outcomes in endovascular therapy has fueled the development of numerous CTA collateral scales, yet synchronized validation with conventional angiography has never occurred. We validated multiphase flat-detector CTA (mpFDCTA) for collateral imaging in patients undergoing endovascular stroke treatment.Materials and methodsConsecutive acute ischemic stroke patient data, including mpFDCTA shortly followed by digital subtraction angiography (DSA), in the setting of acute ICA- or MCA-occlusions were analyzed. An independent core lab scored mpFDCTA with an established collateral scale and separately graded American Society of Interventional and Therapeutic Neuroradiology (ASITN) collateral score on DSA, blind to all other data.Results24 consecutive cases (age 76.7 ± 7.3 years; 58.3% women; baseline NIHSS median 17 (4–23)) of acute ICA- or MCA-occlusion were analyzed. Time from mpFDCTA to intracranial DSA was 23.04 ± 7.6 minutes. Median mpFDCTA collateral score was 3 (0–5) and median DSA ASITN collateral score was 2 (0–3), including the full range of potential collateral grades. mpFDCTA and ASITN collateral score were strongly correlated (r = 0.86, p<0.001). mpFDCTA provided more complete collateral data compared to selective DSA injections in cases of ICA-occlusion. ROC analyses for prediction of clinical outcomes revealed an AUC of 0.76 for mpFDCTA- and 0.70 for DSA ASITN collaterals.ConclusionsmpFDCTA in the angiography suite provides a validated measure of collaterals, offering distinct advantages over conventional angiography. Direct patient transfer to the angiography suite and mpFDCTA collateral grading provides a novel and reliable triage paradigm for acute ischemic stroke.

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Section: Discussionsupporting

confidence: 69%

Validation of collateral scoring on flat-detector multiphase CT angiography in patients with acute ischemic stroke

Maier

Scalzo²,

Leyhe

et al. 2018

PLoS ONE

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“…This confirms prior results of other work groups who used it successfully for evaluating collaterals and the clot-burden score. 15,16 Collaterals can be used as an additional tool for patient selection as pointed out by Schregel et al, 17 who compared the prognostic value of CBV-ASPECTS and collaterals. Although the time resolution of the FPDCT perfusion is 5 seconds lower than the time resolution of the MDCT Perfusion (1.5 seconds), motion artifacts were not a serious issue in our small cohort.…”

Section: Discussionmentioning

confidence: 99%

One-Stop Management with Perfusion for Transfer Patients with Stroke due to a Large-Vessel Occlusion: Feasibility and Effects on In-Hospital Times

Tsogkas

Maier

Eisenberger

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:In-hospital time delays lead to a relevant deterioration of neurologic outcomes in patients with stroke with large-vessel occlusions. At the moment, CT perfusion is relevant in the triage of late-window patients with stroke. We conducted this study to determine whether one-stop management with perfusion is feasible and leads to a reduction of in-hospital times. MATERIALS AND METHODS:In this observational study, we report the first 15 consecutive transfer patients with stroke with externally confirmed large-vessel occlusions who underwent flat panel detector CT perfusion and thrombectomy in the same room. Preinterventional imaging consisted of noncontrast flat panel detector CT and flat panel detector CT perfusion, acquired with a biplane angiography system. The flat panel detector CT perfusion was used to reconstruct a flat panel detector CT angiography to confirm the large-vessel occlusions. After confirmation of the large-vessel occlusion, the patient underwent mechanical thrombectomy. We recorded time metrics and safety parameters prospectively and compared them with those of transfer patients whom we treated before the introduction of one-stop management with perfusion. RESULTS:Fifteen transfer patients underwent flat panel detector CT perfusion and were treated with mechanical thrombectomy from June 2017 to January 2019. The median time from symptom onset to admission was 241 minutes. Median door-to-groin time was 24 minutes. Compared with 23 transfer patients imaged with multidetector CT, it was reduced significantly (24 minutes; 95% CI, 19 -37 minutes, versus 53 minutes; 95% CI, 44 -66 minutes; P Ͻ .001). Safety parameters were comparable between groups. CONCLUSIONS:In this small series, one-stop management with perfusion led to a significant reduction of in-hospital times compared with our previous workflow. ABBREVIATIONS:FPDCT ϭ flat panel detector CT; ICH ϭ intracranial hemorrhage; IQR ϭ interquartile range; LVO ϭ large-vessel occlusion; MDCT ϭ multidetector CT

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“…New, yet prototype-based, 4D-FDCTA could probably improve the delineation of collateral supply and the description of the clot (28). Yang et al recently reported a comprehensive evaluation of vessel occlusions by using time-resolved FDCTA (29). However, these results are based on not commercially available prototypes, where issues such as C-arm rotational speed, patient safety, and radiation exposure first need to be addressed.…”

Section: Discussionmentioning

confidence: 99%

Visualization of large vessel occlusion, clot extent, and collateral supply using volume perfusion flat detector computed tomography in acute stroke patients

et al. 2019

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Background Flat detector computed tomography angiography (FDCTA) can be reconstructed from volume perfusion flat detector computed tomography (VP-FDCT). Thus, CTA equivalent stroke imaging might be feasible within the angio suite. Purpose To evaluate the diagnostic accuracy of FDCTA in detecting large vessel occlusion (LVO) and collateral supply in acute stroke patients. Material and Methods Sixteen patients with LVO of the anterior circulation were analyzed retrospectively. Each patient underwent a multimodal CT stroke protocol, subsequent VP-FDCT, and digital subtraction angiography (DSA) for endovascular stroke therapy. Angiographic images reconstructed secondarily from VP-FDCT were evaluated with regard to visualization of LVO, Collateral Score (CS), Clot Burden Score (CBS), and image quality. Results Image quality of FDCTA was sufficient for diagnosis with a strong correlation between CTA and FDCTA (median score: CTA = 4 ± 0.447; FDCTA = 4 ± 0.5). Detection of LVO could be achieved with high sensitivity and specificity for FDCTA and CTA (97.9%, 95% confidence interval [CI] = 96.0–99.9; 92.6%, 95% CI = 84.3–100.0 vs. 96.8%, 95% CI = 93.2–100.0; 86.3%, 95% CI = 88.2–95.2). CBS and CS assessment showed no significant difference between FDCTA and CTA for both readers (reader1CBS: P = 0.751, reader1CS: P = 0.718; reader2CBS: P = 0.164; reader2CS: P = 0.582) and an excellent interrater agreement (CTACBSICC = 0.984, FDCTACBSICC = 0.951; CTACSICC = 0.754, FDCTACSICC = 0.789). Conclusion FDCTA, reconstructed from VP-FDCT data, allows reliable detection of ICA or MCA M1 segment occlusion comparable to CTA and may provide information concerning the clot extent with sufficient image quality.

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Evaluation of Collaterals and Clot Burden Using Time-Resolved C-Arm Conebeam CT Angiography in the Angiography Suite: A Feasibility Study

Cited by 11 publications

References 18 publications

Validation of collateral scoring on flat-detector multiphase CT angiography in patients with acute ischemic stroke

Validation of collateral scoring on flat-detector multiphase CT angiography in patients with acute ischemic stroke

One-Stop Management with Perfusion for Transfer Patients with Stroke due to a Large-Vessel Occlusion: Feasibility and Effects on In-Hospital Times

Visualization of large vessel occlusion, clot extent, and collateral supply using volume perfusion flat detector computed tomography in acute stroke patients

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