Impact of Multiphase Computed Tomography Angiography for
Endovascular Treatment Decision-Making on Outcomes in Patients
with Acute Ischemic Stroke

J 2021

Impact of Multiphase Computed Tomography Angiography for Endovascular Treatment Decision-Making on Outcomes in Patients with Acute Ischemic Stroke

OSPEL, J. M., Ondřej VOLNÝ, W. QIU, M. NAJM, M. HAFEEZ et. al.

Basic information

Original name

Impact of Multiphase Computed Tomography Angiography for Endovascular Treatment Decision-Making on Outcomes in Patients with Acute Ischemic Stroke

Authors

OSPEL, J. M., Ondřej VOLNÝ (203 Czech Republic, belonging to the institution), W. QIU, M. NAJM, M. HAFEEZ, S. ABDALRAHMAN, E. FAINARDI, M. RUBIERA, A. KHAW, J. J. SHANKAR, M. D. HILL, M. A. ALMEKHLAFI, A. M. DEMCHUK, M. GOYAL and B. K. MENON

Edition

JOURNAL OF STROKE, SEOUL, KOREAN STROKE SOC, 2021, 2287-6391

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30210 Clinical neurology

Country of publisher

Republic of Korea

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 8.632

RIV identification code

RIV/00216224:14110/21:00123032

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.5853/jos.2021.00619

UT WoS

000703882200007

Keywords in English

Ischemic stroke; Ischemia; Cerebrovascular circulation

Abstract

V originále

Background and Purpose Various imaging paradigms are used for endovascular treatment (EVT) decision-making and outcome estimation in acute ischemic stroke (AIS). We aim to compare how these imaging paradigms perform for EVT patient selection and outcome estimation. Methods Prospective multi-center cohort study of patients with AIS symptoms with multi-phase computed tomography angiography (mCTA) and computed tomography perfusion (CTP) baseline imaging. mCTA-based EVT-eligibility was defined as presence of large vessel occlusion (LVO) and moderate-to-good collaterals on mCTA. CTP-based eligibility was defined as presence of LVO, ischemic core (defined on relative cerebral blood flow, absolute cerebral blood flow, and cerebral blood volume maps) <70 mL, mismatch-ratio >1.8, absolute mismatch >15 mL. EVT-eligibility and adjusted rates of good outcome (modified Rankin Scale 0-2) based on these imaging paradigms were compared. Results Of 289/464 patients with LVO, 263 (91%) were EVT-eligible by mCTA-criteria versus 63 (22%), 19 (7%) and 103 (36%) by rCBF, aCBF, and CBV-CTP-criteria. CTP and mCTA-criteria were discordant in 40% to 53%. Estimated outcomes were best in patients who met both mCTA and CTP eligibility-criteria and were treated with EVT (62% to 87% good outcome). Patients eligible for EVT by mCTA-criteria and not by CTP-criteria receiving EVT achieved good outcome rates of 53% to 57%. Few patients met CTP-criteria and not mCTA-criteria for EVT. Conclusions Simpler imaging selection criteria that rely on little else than detection of the occluded blood vessel may be more sensitive and less specific, thus resulting in more patients being offered EVT and arguably benefiting from it.

Citovat

OSPEL, J. M., Ondřej VOLNÝ, W. QIU, M. NAJM, M. HAFEEZ, S. ABDALRAHMAN, E. FAINARDI, M. RUBIERA, A. KHAW, J. J. SHANKAR, M. D. HILL, M. A. ALMEKHLAFI, A. M. DEMCHUK, M. GOYAL and B. K. MENON. Impact of Multiphase Computed Tomography Angiography for Endovascular Treatment Decision-Making on Outcomes in Patients with Acute Ischemic Stroke. JOURNAL OF STROKE. SEOUL: KOREAN STROKE SOC, 2021, vol. 23, No 3, p. "377-387"-"1-6", 17 pp. ISSN 2287-6391. Available from: https://dx.doi.org/10.5853/jos.2021.00619.

@article{1806130,
   author = {Ospel, J. M. and Volný, Ondřej and Qiu, W. and Najm, M. and Hafeez, M. and Abdalrahman, S. and Fainardi, E. and Rubiera, M. and Khaw, A. and Shankar, J. J. and Hill, M. D. and Almekhlafi, M. A. and Demchuk, A. M. and Goyal, M. and Menon, B. K.},
   article_location = {SEOUL},
   article_number = {3},
   doi = {http://dx.doi.org/10.5853/jos.2021.00619},
   keywords = {Ischemic stroke; Ischemia; Cerebrovascular circulation},
   language = {eng},
   issn = {2287-6391},
   journal = {JOURNAL OF STROKE},
   title = {Impact of Multiphase Computed Tomography Angiography for Endovascular Treatment Decision-Making on Outcomes in Patients with Acute Ischemic Stroke},
   url = {https://www.j-stroke.org/journal/view.php?doi=10.5853/jos.2021.00619},
   volume = {23},
   year = {2021}
}

TY  - JOUR
ID  - 1806130
AU  - Ospel, J. M. - Volný, Ondřej - Qiu, W. - Najm, M. - Hafeez, M. - Abdalrahman, S. - Fainardi, E. - Rubiera, M. - Khaw, A. - Shankar, J. J. - Hill, M. D. - Almekhlafi, M. A. - Demchuk, A. M. - Goyal, M. - Menon, B. K.
PY  - 2021
TI  - Impact of Multiphase Computed Tomography Angiography for Endovascular Treatment Decision-Making on Outcomes in Patients with Acute Ischemic Stroke
JF  - JOURNAL OF STROKE
VL  - 23
IS  - 3
SP  - "377-387"-"1-6"
EP  - "377-387"-"1-6"
PB  - KOREAN STROKE SOC
SN  - 22876391
KW  - Ischemic stroke
KW  - Ischemia
KW  - Cerebrovascular circulation
UR  - https://www.j-stroke.org/journal/view.php?doi=10.5853/jos.2021.00619
N2  - Background and Purpose Various imaging paradigms are used for endovascular treatment (EVT) decision-making and outcome estimation in acute ischemic stroke (AIS). We aim to compare how these imaging paradigms perform for EVT patient selection and outcome estimation. Methods Prospective multi-center cohort study of patients with AIS symptoms with multi-phase computed tomography angiography (mCTA) and computed tomography perfusion (CTP) baseline imaging. mCTA-based EVT-eligibility was defined as presence of large vessel occlusion (LVO) and moderate-to-good collaterals on mCTA. CTP-based eligibility was defined as presence of LVO, ischemic core (defined on relative cerebral blood flow, absolute cerebral blood flow, and cerebral blood volume maps) <70 mL, mismatch-ratio >1.8, absolute mismatch >15 mL. EVT-eligibility and adjusted rates of good outcome (modified Rankin Scale 0-2) based on these imaging paradigms were compared. Results Of 289/464 patients with LVO, 263 (91%) were EVT-eligible by mCTA-criteria versus 63 (22%), 19 (7%) and 103 (36%) by rCBF, aCBF, and CBV-CTP-criteria. CTP and mCTA-criteria were discordant in 40% to 53%. Estimated outcomes were best in patients who met both mCTA and CTP eligibility-criteria and were treated with EVT (62% to 87% good outcome). Patients eligible for EVT by mCTA-criteria and not by CTP-criteria receiving EVT achieved good outcome rates of 53% to 57%. Few patients met CTP-criteria and not mCTA-criteria for EVT. Conclusions Simpler imaging selection criteria that rely on little else than detection of the occluded blood vessel may be more sensitive and less specific, thus resulting in more patients being offered EVT and arguably benefiting from it.
ER  -

OSPEL, J. M., Ondřej VOLNÝ, W. QIU, M. NAJM, M. HAFEEZ, S. ABDALRAHMAN, E. FAINARDI, M. RUBIERA, A. KHAW, J. J. SHANKAR, M. D. HILL, M. A. ALMEKHLAFI, A. M. DEMCHUK, M. GOYAL and B. K. MENON. Impact of Multiphase Computed Tomography Angiography for Endovascular Treatment Decision-Making on Outcomes in Patients with Acute Ischemic Stroke. \textit{JOURNAL OF STROKE}. SEOUL: KOREAN STROKE SOC, 2021, vol.~23, No~3, p.~''377-387''-''1-6'', 17 pp. ISSN~2287-6391. Available from: https://dx.doi.org/10.5853/jos.2021.00619.

Detailed Information on Publication Record