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

JM. Ospel, O. Volny, W. Qiu, M. Najm, M. Hafeez, S. Abdalrahman, E. Fainardi, M. Rubiera, A. Khaw, JJ. Shankar, MD. Hill, MA. Almekhlafi, AM. Demchuk, M. Goyal, BK. Menon

. 2021 ; 23 (3) : 377-387. [pub] 20210930

Jazyk angličtina Země Jižní Korea

Typ dokumentu časopisecké články

Perzistentní odkaz   https://www.medvik.cz/link/bmc22001746

Grantová podpora
Canadian Institute of Health Research

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.

Citace poskytuje Crossref.org

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$a Ospel, Johanna M $u Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada $u Department of Radiology, University Hospital of Basel, Basel, Switzerland
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$a 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.
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$a Qiu, Wu $u Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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$a Najm, Mohamed $u Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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$a Hafeez, Moiz $u Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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$a Abdalrahman, Sarah $u Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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$a Fainardi, Enrico $u Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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$a Rubiera, Marta $u Department of Neurology, Hospital Vall d´Hebron, Barcelona, Spain
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$a Khaw, Alexander $u Department of Clinical Neurosciences, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
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$a Shankar, Jai J $u Department of Radiology, University of Manitoba, Winnipeg, MB, Canada
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$a Hill, Michael D $u Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada $u Department of Radiology, University of Calgary, Calgary, AB, Canada $u Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada $u Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada $u Department of Medicine, University of Calgary, Calgary, AB, Canada
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$a Almekhlafi, Mohammed A $u Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada $u Department of Radiology, University of Calgary, Calgary, AB, Canada $u Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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$a Demchuk, Andrew M $u Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada $u Department of Radiology, University of Calgary, Calgary, AB, Canada $u Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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$a Menon, Bijoy K $u Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada $u Department of Radiology, University of Calgary, Calgary, AB, Canada $u Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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