Multiphase CT Angiography: A Useful Technique in Acute Stroke Imaging—Collaterals and Beyond

Dundamadappa, Sathish Kumar; Iyer, Krishna V.; Agrawal, Anushree; Choi, David

doi:10.3174/ajnr.a6889

Cited by 35 publications

(40 citation statements)

References 30 publications

(45 reference statements)

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“…The use of multiphase CTA for collateral assessment avoids this shortcoming of collateral assessment on single-phase CTA 14. In addition, multiphase CTA improves reliability of collateral assessments without added contrast and minimal added radiation exposure when compared with single-phase CTA 20–22. These advantages of multiphase CTA led to its use in clinical trials like ESCAPE and ESCAPE-NA1 that included patients presenting up until 12 hours from last-known-well time 23 24.…”

Section: Discussionmentioning

confidence: 99%

Stroke imaging prior to thrombectomy in the late window: results from a pooled multicentre analysis

Almekhlafi

Thornton

Casetta

et al. 2022

J Neurol Neurosurg Psychiatry

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Background and purposeCollateral assessment using CT angiography is a promising modality for selecting patients for endovascular thrombectomy (EVT) in the late window (6–24 hours). The outcome of these patients compared with those selected using perfusion imaging is not clear.MethodsWe pooled data from seven trials and registries of EVT-treated patients in the late-time window. Patients were classified according to the baseline imaging into collateral imaging alone (collateral cohort) and perfusion plus collateral imaging (perfusion cohort). The primary outcome was the proportion of patients achieving independent 90-day functional outcome (modified Rankin Scale ‘mRS’ 0–2). We used the propensity score–weighting method to balance important predictors between the cohorts.ResultsIn 608 patients, the median onset/last-known-well to emergency arrival time was 8.8 hours and 53.2% had wake-up strokes. Both cohorts had collateral imaging and 379 (62.3%) had perfusion imaging. Independent functional outcome was achieved in 43.1% overall: 168/379 patients (45.5%) in the perfusion cohort versus 94/214 (43.9%) in the collateral cohort (p=0.71). A logistic regression model adjusting for inverse-probability-weighting showed no difference in 90-day mRS score of 0–2 among the perfusion versus collateral cohorts (adjusted OR 1.05, 95% CI 0.69 to 1.59, p=0.83) or in a favourable shift in 90-day mRS (common adjusted OR 1.01, 95% CI 0.69 to 1.47, p=0.97).ConclusionThis pooled analysis of late window EVT showed comparable functional outcomes in patients selected for EVT using collateral imaging alone compared with patients selected using perfusion and collateral imaging.PROSPERO registration numberCRD42020222003.

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Section: Discussionmentioning

confidence: 99%

Stroke imaging prior to thrombectomy in the late window: results from a pooled multicentre analysis

Almekhlafi

Thornton

Casetta

et al. 2022

J Neurol Neurosurg Psychiatry

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“…CTA is a computed tomography technique that visualizes arterial and venous vessels throughout the body. This technique mainly involves the injection of contrast into the peripheral venous vessels, and when the contrast reaches the peak of filling in the peripheral vessels, a spiral CT is used to rapidly collect cross-sectional images to obtain validated raw images, and finally, the raw images are processed by computer to become three-dimensional images of the vessels [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Study on the Relationship between Different Body Mass Indexes and Puncture Pain and Image Quality in Patients Undergoing Coronary Angiography with Intravenous Indwelling Needle

Ding

Chen

2022

Emergency Medicine International

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Objective. To investigate the effect of different body mass indexes (BMIs) on patients’ puncture pain, puncture success rate, and image quality in coronary angiography (CAG) performed with an intravenous indwelling needle, and to provide a basis for selecting the appropriate intravenous indwelling needle for CAG in patients with different BMIs in an outpatient clinic. Method. In this study, 300 patients undergoing CTA at the department of radiology in the First Affiliated Hospital of Wenzhou Medical University from January to May 2021 were divided into group 1 (BMI 1 ≤ 18.5), group 2 (18.5 < BMI ≤ 24), and group 3 (BMI > 24) according to their BMI, with 100 cases in each group, and a 20 G intravenous indwelling needle was used in each group. The age, sex, height, and weight of each patient were recorded, and the primary puncture success rate, contrast leakage rate, injection success rate, pain perception, and subjective ratings of image quality and objective indicators were compared in patients with different BMI values. Results. There was no statistically significant difference between the age, gender, and heart rate of the patients in the three groups ( P > 0.05 ). There was no statistically significant difference between the primary puncture success rate, injection success rate, and contrast leakage rate of the three groups of patients ( P > 0.05 ). The pain scores of group 3 during contrast injection were significantly higher than those of the remaining two groups ( P < 0.05 ), while the differences between the pain scores of group 2 and group 1 during contrast injection were not statistically significant ( P > 0.05 ); the comparison of the pain scores of the three groups during puncture and during retention was not statistically significant ( P > 0.05 ). The differences between the subjective ratings of image quality and the objective indicators of the three groups were not statistically significant ( P > 0.05 ). Conclusion. The 20 G indwelling needle can basically meet the coronary angiography examination of patients with different body mass indexes, but patients with a BMI greater than 24 are recommended to use a larger diameter indwelling needle to reduce contrast leakage as well as to reduce patient pain and improve patient comfort.

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“…The measured thrombus length was based on the absence of contrast as seen in single-phase CTA, supported by the NCCT hyperdense artery sign, if present. Measurements on multiphase CTA might more accurately capture the true thrombus length 30…”

Section: Discussionmentioning

confidence: 99%

Thrombus imaging characteristics within acute ischemic stroke: similarities and interdependence

Terreros

Bruggeman

Kappelhof

et al. 2022

J NeuroIntervent Surg

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BackgroundThe effects of thrombus imaging characteristics on procedural and clinical outcomes after ischemic stroke are increasingly being studied. These thrombus characteristics – for eg, size, location, and density – are commonly analyzed as separate entities. However, it is known that some of these thrombus characteristics are strongly related. Multicollinearity can lead to unreliable prediction models. We aimed to determine the distribution, correlation and clustering of thrombus imaging characteristics based on a large dataset of anterior-circulation acute ischemic stroke patients.MethodsWe measured thrombus imaging characteristics in the MR CLEAN Registry dataset, which included occlusion location, distance from the intracranial carotid artery to the thrombus (DT), thrombus length, density, perviousness, and clot burden score (CBS). We assessed intercorrelations with Spearman’s coefficient (ρ) and grouped thrombi based on 1) occlusion location and 2) thrombus length, density and perviousness using unsupervised clustering.ResultsWe included 934 patients, of which 22% had an internal carotid artery (ICA) occlusion, 61% M1, 16% M2, and 1% another occlusion location. All thrombus characteristics were significantly correlated. Higher CBS was strongly correlated with longer DT (ρ=0.67, p<0.01), and moderately correlated with shorter thrombus length (ρ=−0.41, p<0.01). In more proximal occlusion locations, thrombi were significantly longer, denser, and less pervious. Unsupervised clustering analysis resulted in four thrombus groups; however, the cohesion within and distinction between the groups were weak.ConclusionsThrombus imaging characteristics are significantly intercorrelated – strong correlations should be considered in future predictive modeling studies. Clustering analysis showed there are no distinct thrombus archetypes – novel treatments should consider this thrombus variability.

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Multiphase CT Angiography: A Useful Technique in Acute Stroke Imaging—Collaterals and Beyond

Cited by 35 publications

References 30 publications

Stroke imaging prior to thrombectomy in the late window: results from a pooled multicentre analysis

Stroke imaging prior to thrombectomy in the late window: results from a pooled multicentre analysis

Study on the Relationship between Different Body Mass Indexes and Puncture Pain and Image Quality in Patients Undergoing Coronary Angiography with Intravenous Indwelling Needle

Thrombus imaging characteristics within acute ischemic stroke: similarities and interdependence

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