Multiphase CT Angiography: A New Tool for the Imaging Triage of Patients with Acute Ischemic Stroke

Menon, Bijoy K; d’Esterre, Christopher D; Qazi, Emmad; Almekhlafi, Mohammed; Hahn, L.J.; Demchuk, Andrew M.; Goyal, Mayank

doi:10.1148/radiol.15142256

Cited by 561 publications

(499 citation statements)

References 33 publications

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“…S2 in the Supplementary Appendix). 12 This imaging approach resulted in a low number of imaging protocol violations and enabled the meeting of workflow time targets.…”

Section: Discussionmentioning

confidence: 99%

“…Noncontrast CT and CTA (preferably multiphase) were performed to identify participants with a small infarct core, an occluded proximal artery in the anterior circulation, and moderate-to-good collateral circulation. 14,[25][26][27][28] Multiphase CTA is less vulnerable to patient motion than CT perfusion, requires no additional contrast, and allows for quick determination of collateral status 12 (Fig. S2 in the Supplementary Appendix).…”

Section: Trial Designmentioning

confidence: 99%

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Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke

et al. 2015

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“…S2 in the Supplementary Appendix). 12 This imaging approach resulted in a low number of imaging protocol violations and enabled the meeting of workflow time targets.…”

Section: Discussionmentioning

confidence: 99%

Section: Trial Designmentioning

confidence: 99%

Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke

et al. 2015

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“…2015b). In most institutions, NCCT and CTA constitute the imaging modalities of choice for treatment decision in patients with acute stroke.…”

Section: Discussionmentioning

confidence: 99%

“…2013; Menon et al. 2015b). Although a promising method, CT perfusion was not included in our imaging protocol for stroke patients due to a lack of standardization of the method and as it adds time to image evaluation (Dani et al.…”

Section: Discussionmentioning

confidence: 99%

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Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

et al. 2016

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PurposeClinically successful endovascular therapy (EVT) in ischemic stroke requires reliable noninvasive pretherapeutic selection criteria. We investigated the association of imaging parameters including CT angiographic collaterals and degree of reperfusion with clinical outcome after EVT.MethodsIn our database, we identified 93 patients with large vessel occlusion in the anterior circulation treated with EVT. Besides clinical data, we assessed the baseline Alberta Stroke Program Early CT score (ASPECTS) on noncontrast CT (NCCT) and CT angiography (CTA) source images, collaterals (CT‐CS) and clot burden score (CBS) on CTA and the degree of reperfusion after EVT on angiography. Three readers, blinded to clinical information, evaluated the images in consensus. Data‐driven multivariable ordinal regression analysis identified predictors of good outcome after 90 days as measured with the modified Rankin Scale.ResultsSuccessful angiographic reperfusion (OR 26.50; 95%‐CI 9.33–83.61) and good collaterals (OR 9.69; 95%‐CI 2.28–59.27) were independent predictors of favorable outcome along with female sex (OR 0.35; 95%‐CI 0.14–0.85), younger age (OR 0.88; 95%‐CI 0.83–0.92) and higher NCCT ASPECTS (OR 2.54; 95%‐CI 1.01–6.63). Outcome was best in patients with good collaterals and successful reperfusion, but there was no statistical interaction between collaterals and reperfusion.Conclusions CTA‐collateral status was the strongest pretherapeutic predictor of favorable outcome in ischemic stroke patients treated with EVT. CTA‐collaterals are thus well suited for patient selection in EVT. However, the independent effect of reperfusion on outcome tended to be stronger than that of CTA‐collaterals.

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Association of Clinical, Imaging, and Thrombus Characteristics With Recanalization of Visible Intracranial Occlusion in Patients With Acute Ischemic Stroke

Menon

Al-Ajlan

Najm

et al. 2018

JAMA

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In patients with acute ischemic stroke, more distal thrombus location, greater thrombus permeability, and longer time to recanalization assessment were associated with recanalization of arterial occlusion after administration of intravenous alteplase; among patients who did not receive alteplase, rates of arterial recanalization were low. These findings may help inform treatment and triage decisions in patients with acute ischemic stroke.

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Multiphase CT Angiography: A New Tool for the Imaging Triage of Patients with Acute Ischemic Stroke

Abstract: Multiphase CT angiography is a reliable tool for imaging selection in patients with AIS.

Cited by 561 publications

References 33 publications

Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke

Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke

Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

Association of Clinical, Imaging, and Thrombus Characteristics With Recanalization of Visible Intracranial Occlusion in Patients With Acute Ischemic Stroke

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