Risk and Benefit Evaluation: Application of Multiphase Computed Tomography Angiography in Mechanical Thrombectomy for Patients With Acute Ischemic Stroke

Abstract

Objective:The objective of this study was to evaluate the collateral circulation in patients with acute ischemic stroke (AIS) by multiphase computed tomography angiography (mCTA) and explore its application value in the risk and benefit assessment after thrombectomy.Methods: Clinical and imaging parameters of AIS patients who underwent thrombectomy were consecutively collected. The 90-day modified Rankin Scale (mRS) score was used as the standard for evaluating the recovery of neurological functions. The receiver operating characteristic curve and correlation analysis were used to evaluate the diagnostic efficacy of collateral circulation in the clinical outcomes at 90 days and the correlation with symptomatic intracerebral hemorrhage (sICH), respectively.Results: Thirty of 58 AIS patients (51.7%) had favorable functional recovery (90-day mRS score, ≤2). Significant differences were observed in age, time from symptom onset to groin puncture, National Institutes of Health Stroke Scale score at admission and 24 hours after thrombectomy, mRS score at discharge, collateral circulation score, and target mismatch between the favorable and unfavorable groups (P < 0.05). The diagnostic efficacy of mCTA collateral score (area under the curve, 0.697; 95% confidence interval, 0.563-0.831) was similar to that of computed tomography perfusion target mismatch (area under the curve, 0.740; 95% confidence interval, 0.609-0.872) (DeLong test, P = 0.575). The collateral circulation score was significantly negatively correlated with sICH (ρ = −0.607, P < 0.001). Patients with sICH had lower collateral circulation scores and higher 90-day mRS scores (P < 0.05). Conclusions:The mCTA collateral score has good application value in the risk and benefit evaluation after mechanical thrombectomy, and it is well suited for routine emergency assessment of AIS patients.

Superficial temporal artery–middle cerebral artery bypass in combination with encephalo-myo-synangiosis in Chinese adult patients with moyamoya disease

“…The mRS score reflects the cerebral function, and thus, its improvement may have resulted from enhanced blood perfusion. Previous studies have demonstrated a significant correlation between the mRS score and blood distribution in several neurological deficits, including subarachnoid haemorrhage ( 24 ), acute ischemic stroke ( 25 ) and symptomatic intracerebral haemorrhage ( 26 ). In addition, compared with the mRS score 1 week after surgery, the mRS scores decreased 6 months after surgery.…”

Hemodynamic Characteristics of Intracranial Atherosclerotic Stenosis: A Pilot Study of Contrast Enhancement Time-Density Curves Based on Regions of Interest

“…1 In the prodromal and early stages of AIS, patients' overall prognoses and mortality rates vary greatly due to factors such as the imaging evaluation, mode of prehospital transport, and level of emergency treatment provided. 2 Since 2015, AIS due to large vessel occlusion has been progressively treated with endovascular thrombectomy with intravascular retrievable stent placement, for which prognoses have proved to be better than those for treatment with intravenous recombinant tissue plasminogen activator. After strict case screening, the time window for thrombectomy has been gradually extended from the traditional 6 hours to 16 hours, with some patients still benefitting from this process even 24 hours later.…”

“…An extensive survey conducted globally found that acute ischemic stroke (AIS), characterized as a sudden onset of diminished cerebral blood circulation, was the second leading cause of death in middle-aged and older adults worldwide, after heart disease 1 . In the prodromal and early stages of AIS, patients' overall prognoses and mortality rates vary greatly due to factors such as the imaging evaluation, mode of prehospital transport, and level of emergency treatment provided 2 . Since 2015, AIS due to large vessel occlusion has been progressively treated with endovascular thrombectomy with intravascular retrievable stent placement, for which prognoses have proved to be better than those for treatment with intravenous recombinant tissue plasminogen activator.…”