scholarly journals “Delayed Pial Vessels” in Multiphase CT Angiography Aid in the Detection of Arterial Occlusion in Anterior Circulation

2018 ◽  
Vol 39 (4) ◽  
pp. E47-E47 ◽  
Author(s):  
R.-J. Singh ◽  
C. Zerna ◽  
B.K. Menon
Keyword(s):  
Ct Angiography ◽  
Arterial Occlusion ◽  
Anterior Circulation ◽  
Pial Vessels ◽  
Multiphase Ct

Abstract 3438: Intracranial Arterial Occlusion and Extent of Hypoattenuation on CT Angiography Source Images may Modify the Benefit of Thrombolysis

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Imanuel Dzialowski ◽  
Volker Puetz ◽  
Jasmin Renger ◽  
Andrei Khomenko ◽  
Ulf Bodechtel ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Ct Angiography ◽  
Time Window ◽  
Brain Infarction ◽  
Randomized Study ◽  
Arterial Occlusion ◽  
Extended Time ◽  
Anterior Circulation ◽  
Nihss Score ◽  
Mca Occlusion

Background: CT angiography source images (CTASI) improve diagnostic accuracy for ischemic brain infarction compared to non-contrast CT (NCCT). We studied whether CTASI alone or combined with the CTA occlusion status may improve patient selection for thrombolysis in an extended time window. Methods: We prospectively observed patients presenting with anterior circulation ischemic stroke within 12 hours from symptom onset and an NIHSS score ≥ 3. All patients underwent cranial NCCT and CTA. Patients were treated with intravenous and/or intra-arterial thrombolysis at the discretion of the treating stroke neurologist and neuroloradiologist. We determined intracranial occlusion status and applied the Alberta Stroke Program Early CT Score (ASPECTS) to CTASI. Primary clinical outcome measure was independent outcome at 3 months, defined as mRS scores 0-2. We calculated unadjusted risk ratios to assess the effect of thrombolysis on functional outcome in patients with: 1) minor ischemic changes on CTASI (CTASI-ASPECTS >5) and 2) patients with minor ischemic changes on CTASI and middle cerebral artery (MCA) occlusion. Results: We enrolled 102 patients with a mean age of 71 +/- 12 years, median onset-to-CTA time of 112,5 (range 37-898) min, a median NIHSS score of 9.5 (3-39), and a median CTASI-ASPECTS of 8. Sixty-two patients (61%) received any thrombolysis (56 IV, 5 IV/IA, 1 IA). MCA occlusion was present in 57 patients (56%), 80/101 (80%) assessable patients had a CTASI-ASPECTS >5 and 37/101 (37%) patients had a CTASI-ASPECTS >5 in the presence of a MCA occlusion. At 3 months, 52 (51%) patients had an independent functional outcome. When patients with CTA-SI ASPECTS > 5 received thrombolysis, 30/46 (65%) achieved an independent functional outcome, whereas 20/35 (57%) without thrombolysis were functionally independent (RR 1.1, CI 95 0.8-1.6). In patients with CTASI-ASPECTS > 5 and additional MCA-occlusion, 13/24 (54%) with thrombolysis and 3/13 (23%) without thrombolysis achieved an independent functional outcome (RR 2.3, CI 95 0.8-6.8). Conclusion: In our non-randomized study, the extent of CTASI hypoattenuation alone did not identify patients benefiting from thrombolysis. In the presence of an MCA-occlusion, however, CTASI might identify patients with benefit from thrombolysis in an extended time window.

scholarly journals Prognostic Evaluation Based on Cortical Vein Score Difference in Stroke

Stroke ◽  
2013 ◽  
Vol 44 (10) ◽  
pp. 2748-2754 ◽  
Author(s):  
Rajsrinivas Parthasarathy ◽  
Mahesh Kate ◽  
Jeremy L. Rempel ◽  
David S. Liebeskind ◽  
Thomas Jeerakathil ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Odds Ratio ◽  
Arterial Occlusion ◽  
Venous Drainage ◽  
Cerebral Vein ◽  
Anterior Circulation ◽  
Prognostic Evaluation ◽  
Cortical Vein ◽  
Score Difference ◽  
Superficial Middle Cerebral Vein

Background and Purpose— Multimodal imaging in acute ischemic stroke defines the extent of arterial collaterals, resultant penumbra, and associated infarct core, yet limitations abound. We identified superficial and deep venous drainage patterns that predict outcomes in patients with a proximal arterial occlusion of the anterior circulation. Methods— An observational study that used computed tomography (CT) angiography to detail venous drainage in a consecutive series of patients with a proximal anterior circulation arterial occlusion. The principal veins that drain the cortex (superficial middle cerebral, vein of Trolard, vein of Labbé, and basal vein of Rosenthal) and deep structures were scored with a categorical scale on the basis of degree of contrast enhancement. The Prognostic Evaluation based on Cortical vein score difference In Stroke score encompassing the interhemispheric difference of the composite scores of the veins draining the cortices (superficial middle cerebral+vein of Trolard+vein of Labbé+basal vein of Rosenthal) was analyzed with respect to 90-day modified Rankin Scale outcomes. Results— Thirty-nine patients were included in the study. A Prognostic Evaluation based on Cortical vein score difference In Stroke score of 4 to 8 accurately predicted poor outcomes (modified Rankin Scale, 3–6; odds ratio, 20.53; P <0.001). On stepwise logistic regression analyses adjusted for CT Alberta stroke program early CT score, CT angiography collateral grading and National Institutes of Health Stroke Scale score, a Prognostic Evaluation based on Cortical vein score difference In Stroke score of 4 to 8 (odds ratio, 23.598; P =0.009) and an elevated admission National Institutes of Health Stroke Scale (odds ratio, 1.423; P =0.023) were independent predictors of poor outcome. Conclusions— The Prognostic Evaluation based on Cortical vein score difference In Stroke score, a novel measure of venous enhancement on CT angiography, accurately predicts clinical outcomes. Venous features on computed tomography angiography provide additional characterization of collateral perfusion and prognostication in acute ischemic stroke.

scholarly journals Improved Detection of Anterior Circulation Occlusions: The “Delayed Vessel Sign” on Multiphase CT Angiography

2017 ◽  
Vol 38 (10) ◽  
pp. 1911-1916 ◽  
Author(s):  
D. Byrne ◽  
G. Sugrue ◽  
E. Stanley ◽  
J.P. Walsh ◽  
S. Murphy ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Anterior Circulation ◽  
Multiphase Ct

scholarly journals Multiphase CT angiography increases detection of anterior circulation intracranial occlusion

Neurology ◽  
2016 ◽  
pp. 10.1212/WNL.0000000000002951 ◽  
Author(s):  
Amy Y. X. Yu ◽  
Charlotte Zerna ◽  
Zarina Assis ◽  
Jessalyn K. Holodinsky ◽  
Privia A. Randhawa ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Anterior Circulation ◽  
Multiphase Ct

scholarly journals CT Angiography in an Acute Stroke Protocol: Correlation between Occlusion Site and Outcome of Intravenous Thrombolysis

2013 ◽  
Vol 19 (1) ◽  
pp. 87-96 ◽  
Author(s):  
S. Porelli ◽  
M. Leonardi ◽  
A. Stafa ◽  
C. Barbara ◽  
G. Procaccianti ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Acute Stroke ◽  
Ct Angiography ◽  
Treatment Effectiveness ◽  
Arterial Occlusion ◽  
Intravenous Thrombolysis ◽  
Current Therapy ◽  
Anterior Circulation ◽  
Hemorrhagic Complications ◽  
Treatment Safety

Thrombolysis with intravenous rt-PA is the current therapy for acute ischemic stroke. Unlike other outcome factors, relatively little is known about the prognostic value of the occlusion site on treatment outcome. We compared the effectiveness and safety of intravenous thrombolysis in patients with different levels of occlusion identified by CT angiography (CTA) in anterior circulation stroke, and analyzed the influence of the occlusion site on treatment outcome in relation to other outcome factors. We selected 71 patients from a stroke database collected between June 2007 and December 2011 at our hospital. All of the studied patients had anterior circulation stroke with intracranial occlusion detected by CTA and were treated with intravenous rt-PA. They were divided into two groups according to the site of occlusion along the middle cerebral artery course: proximal (carotid “T”, complete M1 and mild M1 occlusions) and distal (M2/M3 occlusions). Treatment effectiveness was assessed by modified Rankin Scale (mRS) at three months, considering a positive outcome a mRS value ≤ 2. Treatment safety was assessed by evaluating the rate of hemorrhagic complications seen on unenhanced CT at 24 hours. Binary logistic regression was performed to evaluate the interaction between occlusion site and other variables such as sex, age, ASPECT score on admission and baseline NIHSS value in determining treatment outcome. The degree of effectiveness and safety differed when considering patients with proximal and distal occlusions. The percentage of successfully treated cases was 28.6% in the first group compared to 72% in the second, and the rate of hemorrhagic complications was 28.6% and 6% respectively. After adjustment for sex, age, ASPECT score on admission and baseline NIHSS value, occlusion site was the only variable significantly influencing treatment safety and, together with baseline NIHSS value, the only valid predictor of treatment effectiveness. We demonstrated a correlation between the site of arterial occlusion and outcome of intravenous thrombolysis. By helping the choice of the best therapeutic strategy depending on the identified occlusion site, CTA could be usefully added to the examinations included in the Stroke Protocol for the baseline evaluation of patients with suspected acute stroke.

Abstract 182: Thermal Imaging as a Diagnostic Biomarker in Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Linda F Aulmann ◽  
Kira Busch ◽  
Andrea Zegelin ◽  
Thomas Eckey ◽  
Alexander Neumann ◽  
...  
Keyword(s):  
Thermal Imaging ◽  
Arterial Occlusion ◽  
Current Method ◽  
Contralateral Side ◽  
Temperature Pattern ◽  
Ipsilateral Side ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Clear Trend ◽  
Infrared Thermal Imaging

Purpose: With highly portable mobile infrared cameras thermal imaging during acute stroke triage has become possible. The purpose of this pilot study was to evaluate the pattern of superficial facial skin temperature in patients with acute proximal arterial occlusion of the anterior circulation compared to non-ischemic controls. We hypothesize, that temperature dysregulation in stroke with associated thermal pattern may be used to predict presence of proximal vessel occlusion. Methods: In 46 patients suffering from acute occlusion in the anterior circulation (ICA: 17, M1-MCA: 13, M2-MCA: 16) infrared thermal imaging of the face was performed before endovascular treatment. Asymmetric temperature patterns were evaluated visually. Quantitative temperature values were obtained from regions of interest (ROIs) placed symmetrically on the left and right half of on the facial thermal image. Presence and side of vessel occlusion was correlated with temperature measurements. Results: Regional facial asymmetric temperature was readily visible at 0.5°C. Temperature differences ranged from 0.5 to 1.5° C in stroke patients, and <0.5°C in controls. In 16 of 17 patients with ICA occlusion, facial asymmetric temperature was detected (in 13 lower temperatures on ipsilateral side, in 3 on the contralateral side). In 11 of 13 patients with M1-MCA occlusion, facial asymmetric temperature was detected (in 8 lower temperatures on the contralateral side, 3 on the ipsilateral side). In 15 of 16 patients with an occlusion of M2-segment, asymmetric temperature pattern was apparent, however no clear trend with regard. In 16 of 20 controls, no asymmetric temperature pattern >0.5°C was observed. Conclusion: Thermal imaging could serve as a fast point-of-care test to detect asymmetrical pattern in facial temperature as a predictor of proximal vessel occlusion in stroke. However, the current method is prone to imaging artifacts and reliability of detected asymmetry is moderate.

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