Imaging Predictors for Atherosclerosis-Related Intracranial Large Artery Occlusions in Acute Anterior Circulation Stroke

Suh, Hong Il; Hong, Ji Man; Lee, Kyu-Sun; Han, Miran; Choi, Jin Wook; Kim, Jong Seung; Demchuk, Andrew M.; Lee, Jin Soo

doi:10.5853/jos.2016.00283

Cited by 32 publications

(35 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Common cardioembolic sources such as atrial fibrillation or valvular heart diseases are typically considered as evidence of an embolic occlusion of an intracranial artery [ 7 ]. Specific imaging findings—for example, a hyperdense artery sign on CT or a blooming artifact on magnetic resonance imaging—have also been regarded as markers of embolic occlusion [ 14 , 20 ]. Uniquely, the occlusion type observed on preprocedural CTA was significantly associated with occlusion pathomechanism.…”

Section: Discussionmentioning

confidence: 99%

“…Particular infarct patterns could also be helpful in determining the occlusion pathomechanism. However, the infarct pattern is less evident and may be limited in the preprocedural condition [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Instead, it was reported that initial infarct volume was smaller among patients with an ICAS-LVO. This merely indirectly suggested that leptomeningeal collaterals were better in ICAS-LVO [ 7 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Utility of Leptomeningeal Collaterals in Predicting Intracranial Atherosclerosis-Related Large Vessel Occlusion in Endovascular Treatment

Baek

Kim

et al. 2020

JCM

View full text Add to dashboard Cite

Earlier or preprocedural identification of occlusion pathomechanism is crucial for effective endovascular treatment. As leptomeningeal collaterals tend to develop well in chronic ischemic conditions such as intracranial atherosclerosis (ICAS), we investigated whether leptomeningeal collaterals can be a preprocedural marker of ICAS-related large vessel occlusion (ICAS-LVO) in endovascular treatment. A total of 226 patients who underwent endovascular treatment were retrospectively reviewed. We compared the pattern of leptomeningeal collaterals between patients with ICAS-LVO and without. Leptomeningeal collaterals were assessed by preprocedural computed tomography angiography (CTA) and basically categorized by three different collateral assessment methods. Better leptomeningeal collaterals were significantly associated with ICAS-LVO, although they were not independent for ICAS-LVO. When leptomeningeal collaterals were dichotomized to incomplete (<100%) and complete (100%), the latter was significantly more frequent in patients with ICAS-LVO (52.5% versus 20.4%) and remained an independent factor for ICAS-LVO (odds ratio, 3.32; 95% confidence interval, 1.52–7.26; p = 0.003). The area under the curve (AUC) value of complete leptomeningeal collateral supply was 0.660 for discrimination of ICAS-LVO. Incomplete leptomeningeal collateral supply was not likely ICAS-LVO, based on the high negative predictive value (88.6%). Considering its negative predictive value and the independent association between complete leptomeningeal collateral supply and ICAS-LVO, leptomeningeal collaterals could be helpful in the preprocedural determination of occlusion pathomechanism.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Utility of Leptomeningeal Collaterals in Predicting Intracranial Atherosclerosis-Related Large Vessel Occlusion in Endovascular Treatment

Baek

Kim

et al. 2020

JCM

View full text Add to dashboard Cite

show abstract

“…Patients with preformed ICAS can have universally good collaterals, which are developed by hypoperfusion with stenosis [ 37 ]. In an anecdotal study, the baseline infarct core volume was significantly lower in patients with ICAS-related occlusion compared to those with embolic occlusion [ 38 ]. Compared to early window trials using target artery occlusion and small core volume mostly based on noncontrast CT such as ASPECTS, these late window trials are based on infarct core volume with clinical or perfusion mismatch.…”

Section: Discussionmentioning

confidence: 99%

Prognosis of Acute Intracranial Atherosclerosis-Related Occlusion after Endovascular Treatment

et al. 2018

Self Cite

View full text Add to dashboard Cite

Background and PurposeLittle is known about prognosis after endovascular therapy (EVT) for acute large artery occlusion (LAO) caused by underlying intracranial atherosclerotic stenosis (ICAS). Therefore, we investigated the prognosis following EVT according to the underlying etiology of LAO. MethodsPatients from the Acute Stroke due to Intracranial Atherosclerotic occlusion and Neurointervention-Korean Retrospective (ASIAN KR) registry (n=720) were included if their occlusion was in the intracranial anterior circulation and their onset-to-puncture time was <24 hours. Occlusion was classified according to etiology as follows: no significant stenosis after recanalization (Embolic group), and fixed significant focal stenosis in the occlusion site with flow impairment or re-occlusion observed during EVT (ICAS group). Patients were excluded when significant extracranial carotid lesions existed, and when the intracranial occlusion was intractable to EVT so that the etiology was undetermined. The effect of angiographic etiologic classification on outcomes was evaluated using multivariable analysis that was adjusted for potential confounders. ResultsAmong eligible patients (n=520), 421 and 99 were classified in the Embolic and ICAS groups, respectively. Patients in the Embolic and ICAS groups had similar successful reperfusion rates with EVT (79.6% vs. 76.8%, P=0.537) and 3-month functional independence (54.5% vs. 45.5%, P=0.104). In multivariable analysis, ICAS-related occlusion (odds ratio, 0.495; 95% confidence interval, 0.269 to 0.913; P=0.024) showed poorer 3-month functional independence compared to embolic occlusion. ConclusionsAfter EVT, patients with acute ICAS-related occlusion have relatively poor functional outcomes compared to those with embolic occlusion. Novel strategies need to be developed to improve EVT outcomes for ICAS occlusion.

show abstract

“…An important issue regarding ICAS-related occlusion is its preprocedural identification (23, 24). DSA-determined TTO is another surrogate marker of ICAS-related occlusion that can potentially address this issue.…”

Section: Introductionmentioning

confidence: 99%

CTA-Based Truncal-Type Occlusion Is Best Matched With Postprocedural Fixed Focal Stenosis in Vertebrobasilar Occlusions

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background: Differentiation of embolic and atherosclerotic occlusions is difficult prior to endovascular treatment (EVT) of acute ischemic stroke due to intracranial large artery occlusions. CTA-determined occlusion type has been reported to be associated with a negative cardiac embolic source and stent retriever failure, a potential of intracranial atherosclerosis (ICAS)-related occlusions. In this study, we evaluated the agreement between preprocedural identification of CTA-determined truncal-type occlusion (TTO) and postprocedural evaluation of underlying fixed focal stenosis (FFS) in the occlusion site.Methods: Patients who underwent intracranial EVT for acute ischemic stroke within 24 h of onset and who had baseline CTA were identified from a multicenter registry collected between January 2011 and May 2016. Preprocedural occlusion type was classified as TTO (target artery bifurcation saved) or branching-site occlusion (bifurcation involved) on CTA. As for postprocedural identification, FFS was evaluated by stepwise analyses of procedural and postprocedural angiographies. The agreement between TTO and FFS was evaluated in respective intracranial vascular beds. Receiver operating characteristics analyses were also performed.Results: A total of 509 patients were included [intracranial internal carotid artery (ICA): 193, middle cerebral artery (MCA) M1: 256, and vertebrobasilar artery (VBA): 60]. In preprocedural identification, 33 (17.1%), 41 (16.0%), and 29 patients (48.3%) had TTOs, respectively. TTOs had good agreement with angiographic FFS in M1 (positive predictive value: 63.4%, negative predictive value: 83.2%, likelihood ratio: 5.42, Pmultivariate < 0.001) and VBA (72.4%, 96.8%, and 4.54, respectively, Pmultivariate = 0.004), but not in intracranial ICA occlusions (Pmultivariate = 0.358). The area under the receiver operating characteristics curve was the largest for VBA (0.872, p < 0.001), followed by MCA M1 (0.671, p < 0.001), and intracranial ICA (0.551, p = 0.465).Conclusions: Agreement between preprocedural TTO and postprocedural FFS, both of which are surrogate markers for ICAS-related occlusions, is highest for VBA, followed by MCA M1 occlusions. There is no significant association in intracranial ICA.

show abstract

Imaging Predictors for Atherosclerosis-Related Intracranial Large Artery Occlusions in Acute Anterior Circulation Stroke

Cited by 32 publications

References 12 publications

Utility of Leptomeningeal Collaterals in Predicting Intracranial Atherosclerosis-Related Large Vessel Occlusion in Endovascular Treatment

Utility of Leptomeningeal Collaterals in Predicting Intracranial Atherosclerosis-Related Large Vessel Occlusion in Endovascular Treatment

Prognosis of Acute Intracranial Atherosclerosis-Related Occlusion after Endovascular Treatment

CTA-Based Truncal-Type Occlusion Is Best Matched With Postprocedural Fixed Focal Stenosis in Vertebrobasilar Occlusions

Contact Info

Product

Resources

About