Quantitative Collateral Assessment on CTP in the Prediction of Stroke Etiology

Shi, Feina; Zeng, Qiang; Gong, Xiaoxian; Zhong, Wansi; Chen, Z; Yan, Shiyu; Lou, Min

doi:10.3174/ajnr.a7549

Cited by 3 publications

(1 citation statement)

References 33 publications

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“…Clot length may be a simple, fast, and widely available method in the emergency setting. In terms of the CS, a previous study ( 19 ) revealed that collaterals on CT perfusion images showed an excellent ability to identify the stroke classification with an AUC value of 0.87, which is higher than the AUC value observed in the present study. The reason for this discrepancy may lie in the influence of vascular variation, slow blood flow, and leukoaraiosis on the collateral circulation ( 20 ).…”

Section: Discussioncontrasting

confidence: 93%

Imaging features of cardioembolic stroke on 4-dimensional computed tomography angiography

Wu,

Liu,

Wang

et al. 2023

Quant Imaging Med Surg

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Background Identifying cardioembolic stroke is important for the decision-making of endovascular treatment and anticoagulation therapy. We aimed to explore the features of cardioembolic stroke on 4-dimensional (4D) computed tomography angiography (4D-CTA) and assess whether these features can assist in classifying stroke etiology. Methods In this retrospective study, we analyzed the images of 294 patients with acute ischemic stroke (AIS) from July 2020 to February 2022 at the First Affiliated Hospital of Chongqing Medical University, which had been consecutively collected. The data of 110 patients with occlusion of the M1/M2 segment of the middle cerebral artery (MCA) with/without intracranial internal carotid artery (ICA) occlusion were analyzed to calculate the clot burden score (CBS) and collateral score (CS), and the data of 88 patients with a clear origin and distal part were analyzed to measure clot length. Maximum intensity projection (MIP) and time MIP (tMIP) post-processing were used to assess the clot features. The Mann-Whitney U test was used to compare the clot characteristics between the 2 groups. Binary logistic regression was performed to assess the association between the image characteristics and cardioembolic stroke. Moreover, the receiver operating characteristic (ROC) curve was used to test the diagnostic efficacy of MIP/tMIP clot features in classifying cardioembolic stroke. Results Age, high-risk factors for cerebrovascular disease, high/medium-risk sources of cardioembolic stroke, clot length, CBS, and CS were significantly different between the cardioembolic stroke group and non-cardioembolic stroke group (P<0.05). In the cardioembolic stroke group, the median MIP and tMIP clot length was 12 mm [interquartile range (IQR), 8.3–17.4 mm] and 9.3 mm (IQR, 6.8–14.3 mm), respectively. In the non-cardioembolic stroke group, the median MIP and tMIP clot length was 6.5 mm (IQR, 4.7–11.5 mm) and 5.8 mm (IQR, 3.9–10.6 mm), respectively. Binary logistic regression showed that cardioembolic stroke was significantly associated with MIP-clot length [odds ratio (OR), 1.15; 95% confidence interval (CI): 1.02–1.29; P<0.05], tMIP-clot length (OR, 1.18; 95% CI: 1.02–1.36; P<0.05), and tMIP-CBS (OR, 3.96; 95% CI: 1.08–14.58; P<0.05). The area under the ROC curve (AUC) values of MIP clot length for identifying cardioembolic stroke were 0.75 (95% CI: 0.65–0.84, P<0.05), with a cut-off value of >7.4 mm [sensitivity: 84.62% (95% CI: 69.50–94.10%); specificity: 59.18% (95% CI: 44.20–73.00%)]. The AUC value of tMIP clot length was 0.72 (95% CI: 0.61–0.81, P<0.05), with a cut-off value of >5.4 mm [sensitivity: 92.31% (95% CI: 79.10–98.40%); specificity: 48.98% (95% CI: 34.40–63.70%)]. Conclusions Clot length and CBS were overestimated on MIP images. Among the clot characteristics, clot length could identify cardioembolic stroke.

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Section: Discussioncontrasting

confidence: 93%

Imaging features of cardioembolic stroke on 4-dimensional computed tomography angiography

Wu,

Liu,

Wang

et al. 2023

Quant Imaging Med Surg

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Futile recanalization in patients with basilar artery occlusion: assessment of the underlying etiology and the role of perfusion imaging

Baik,

Jung,

Kim

et al. 2024

J NeuroIntervent Surg

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BackgroundFutile recanalization (FR) after endovascular therapy (EVT) is common in basilar artery occlusion (BAO). The purpose of this study was to investigate the predictors of FR in the posterior circulation with an emphasis on the role of perfusion imaging and its relation to the underlying etiology.MethodsWe included BAO patients who had pretreatment perfusion imaging and successful recanalization after EVT. Patients were dichotomized into futile and non-futile groups according to the favorable functional outcome at 90 days (modified Rankin Scale (mRS) 0–3). Perfusion abnormalities were assessed using an automated software for Tmax volume measurement and identification of hypoperfusion area based on Tmax>6 s involvement of the pons-midbrain-thalamus (PMT), cerebellum, and temporo-occipital lobe.ResultsOf the 134 enrolled patients, the incidence of FR was 47.8% (64/134). Multivariate logistic analysis showed that a higher National Institutes of Health Stroke Scale (NIHSS) score on admission (adjusted OR (aOR) 1.066; 95% CI 1.011 to 1.125), a longer onset-to-recanalization time (aOR 1.002; 95% CI 1.001 to 1.004), incomplete recanalization (aOR 3.909; 95% CI 1.498 to 10.200), and PMT hypoperfusion (aOR 4.444; 95% CI 1.203 to 16.415) were independent predictors of FR. In patients with embolic occlusion of etiology, PMT hypoperfusion was associated with FR (aOR 8.379; 95% CI 1.377 to 50.994), whereas intracranial atherosclerotic stenosis (ICAS)-related occlusion was not (p=0.587).ConclusionsIn patients with BAO, the likelihood of FR is associated with PMT hypoperfusion on pretreatment perfusion imaging. In particular, PMT hypoperfusion may be used as an imaging predictor of FR in patients with embolic cause of BAO.

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Predicting Recanalization Failure With Conventional Devices During Endovascular Treatment Related to Vessel Occlusion

Flores,

Elizalde,

Seró

et al. 2024

SVIN

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BACKGROUND Among patients with stroke eligible for endovascular treatment, preprocedure identification of those with low chances of successful recanalization with conventional devices (stent‐retrievers and/or direct aspiration) may allow anticipating procedural rescue strategies. We aimed to develop a preprocedural algorithm able to predict recanalization failure with conventional devices (RFCD). METHODS Observational study. Data from consecutive patients with stroke who received endovascular treatment between 2019 and 2022 in 10 centers were collected from the Catalan Stroke Registry (Codi Ictus Catalunya Registry, CICAT). RFCD was defined as final thrombolysis in cerebral infarction ≤2a or the use of rescue therapy defined as balloon angioplasty±stent deployment. Univariate and multivariate analysis to identify variables associated with RFCD were performed. A gradient boosted decision tree machine learning model to predict RFCD was developed utilizing preprocedure variables previously selected. Clinical improvement at 24 hours was defined as a drop of ≥4 points from baseline National Institutes of Health Stroke Scale score or 0–1 at 24 hours. RESULTS In total, 984 patients were included; RFCD was observed in 14.3% (n:141) of the cases. Of these, 47.5% (n = 67) received balloon angioplasty±stent deployment as rescue therapy. Among patients receiving balloon angioplasty±stent deployment, clinical improvement was associated with lower number of attempts with conventional devices (median number of passes 2 versus 3; P = 0.045). In logistic regression, the absence of atrial fibrillation (odds ratio [OR]: 2.730, 95%CI: 1.541–4.836; P = 0.007) and no‐thrombolytic treatment (OR: 1.826, 95%CI: 1.230–2.711; P = 0.003) emerged as independent predictors of RFCD. A predictive model for RFCD, based on age, sex, hypertension, wake‐up stroke, baseline National Institutes of Health Stroke Scale score, Alberta Stroke Program Early CT [Computed Tomography] Score, occlusion site, thrombolysis, and atrial fibrillation showed an acceptable discrimination (area under the curve: 0.72±0.024 SD) and accuracy (0.75±0.015 SD). Overall performance was moderate (weighted F1‐score: 0.77±0.041 SD). CONCLUSION In RFCD patients, early balloon angioplasty±stent deployment rescue was associated with improved outcomes. A predictive model using affordable preprocedure clinical variables could be useful to identify these patients before intervention.

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Quantitative Collateral Assessment on CTP in the Prediction of Stroke Etiology

Cited by 3 publications

References 33 publications

Imaging features of cardioembolic stroke on 4-dimensional computed tomography angiography

Imaging features of cardioembolic stroke on 4-dimensional computed tomography angiography

Futile recanalization in patients with basilar artery occlusion: assessment of the underlying etiology and the role of perfusion imaging

Predicting Recanalization Failure With Conventional Devices During Endovascular Treatment Related to Vessel Occlusion

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