Quantitative CT angiography predicts large artery occlusion types and successful thrombectomy in acute ischemic stroke

Chun Chien; Chun Jen Lin; Feng Chi Chang; Chih Ping Chung; Chung Jung Lin; Hung Yu Liu; Nai Fang Chi; Li Chi Hsu; Chih Wei Tang; Wan Yuo Guo; Chao Bao Luo; Yen Jun Lai; I. Hui Lee

doi:10.1097/JCMA.0000000000000434

Quantitative CT angiography predicts large artery occlusion types and successful thrombectomy in acute ischemic stroke

Chun Chien, Chun Jen Lin, Feng Chi Chang, Chih Ping Chung, Chung Jung Lin, Hung Yu Liu, Nai Fang Chi, Li Chi Hsu, Chih Wei Tang, Wan Yuo Guo, Chao Bao Luo, Yen Jun Lai, I. Hui Lee

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

Background: Clinical and radiological outcomes of endovascular thrombectomy (EVT) are related to etiologies of large vessel occlusion (LVO) in acute stroke. However, preprocedural computed tomography angiography (CTA) or CT perfusion imaging can hardly distinguish embolic occlusion from atherosclerotic occlusion. We hypothesized that quantitative multiphase CTA (mCTA) of LVO may predict occlusion types and thrombectomy outcome. Methods: We retrospectively evaluated the consecutive stroke patients who had undergone mCTA and EVT <6 hours of onset at two independent medical centers. The intra-arterial radiodensities of Hounsfield unit (HU) were measured to examine the HU_{distal/proximal} ratio using receiver operating characteristic curve analysis. The derived cut-off value was re-examined in an independent cohort. Results: In the derivation cohort (n = 102), 81 patients (79.4%) were embolic occlusion without severe residual intracranial atherosclerotic stenosis (ICAS[−]) and 21 patients were atherosclerosis-related occlusion (ICAS[+]) based on digital subtraction angiography (DSA). The optimal cut-off to predict embolic occlusion was HU ratio <0.6 measured at 2 mm from the occlusion site (maximum area under the curve = 0.87; sensitivity 96%; specificity 81%). This cut-off also independently predicted successful recanalization using stent-retrievers and/or contact aspiration (modified Treatment in Cerebral Ischemia score ≥2b; p = 0.002) after adjusting for age, atrial fibrillation, and collateral circulation score, but not predicted favorable outcome at 3 months post stroke. Importantly, in the validation cohort (n = 95, 80% embolic occlusion), this HU ratio cut-off similarly predicted occlusion types and recanalization outcome, respectively. Conclusion: The mCTA-based quantitative radiodensities of acute LVO provides preprocedural predictive values of DSA-determined occlusion types and thrombectomy outcomes.

Original language	English
Pages (from-to)	61-67
Number of pages	7
Journal	Journal of the Chinese Medical Association
Volume	84
Issue number	1
DOIs	https://doi.org/10.1097/JCMA.0000000000000434
Publication status	Published - Jan 2021
Externally published	Yes

Keywords

Computed tomography angiography
Intracranial arteriosclerosis
Stroke
Thrombectomy

ASJC Scopus subject areas

General Medicine

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10.1097/JCMA.0000000000000434

Cite this

Chien, C., Lin, C. J., Chang, F. C., Chung, C. P., Lin, C. J., Liu, H. Y., Chi, N. F., Hsu, L. C., Tang, C. W., Guo, W. Y., Luo, C. B., Lai, Y. J., & Lee, I. H. (2021). Quantitative CT angiography predicts large artery occlusion types and successful thrombectomy in acute ischemic stroke. Journal of the Chinese Medical Association, 84(1), 61-67. https://doi.org/10.1097/JCMA.0000000000000434

@article{bb4fb0b07ff94a0c87f1b226ca2070d0,

title = "Quantitative CT angiography predicts large artery occlusion types and successful thrombectomy in acute ischemic stroke",

abstract = "Background: Clinical and radiological outcomes of endovascular thrombectomy (EVT) are related to etiologies of large vessel occlusion (LVO) in acute stroke. However, preprocedural computed tomography angiography (CTA) or CT perfusion imaging can hardly distinguish embolic occlusion from atherosclerotic occlusion. We hypothesized that quantitative multiphase CTA (mCTA) of LVO may predict occlusion types and thrombectomy outcome. Methods: We retrospectively evaluated the consecutive stroke patients who had undergone mCTA and EVT <6 hours of onset at two independent medical centers. The intra-arterial radiodensities of Hounsfield unit (HU) were measured to examine the HUdistal/proximal ratio using receiver operating characteristic curve analysis. The derived cut-off value was re-examined in an independent cohort. Results: In the derivation cohort (n = 102), 81 patients (79.4%) were embolic occlusion without severe residual intracranial atherosclerotic stenosis (ICAS[−]) and 21 patients were atherosclerosis-related occlusion (ICAS[+]) based on digital subtraction angiography (DSA). The optimal cut-off to predict embolic occlusion was HU ratio <0.6 measured at 2 mm from the occlusion site (maximum area under the curve = 0.87; sensitivity 96%; specificity 81%). This cut-off also independently predicted successful recanalization using stent-retrievers and/or contact aspiration (modified Treatment in Cerebral Ischemia score ≥2b; p = 0.002) after adjusting for age, atrial fibrillation, and collateral circulation score, but not predicted favorable outcome at 3 months post stroke. Importantly, in the validation cohort (n = 95, 80% embolic occlusion), this HU ratio cut-off similarly predicted occlusion types and recanalization outcome, respectively. Conclusion: The mCTA-based quantitative radiodensities of acute LVO provides preprocedural predictive values of DSA-determined occlusion types and thrombectomy outcomes.",

keywords = "Computed tomography angiography, Intracranial arteriosclerosis, Stroke, Thrombectomy",

author = "Chun Chien and Lin, {Chun Jen} and Chang, {Feng Chi} and Chung, {Chih Ping} and Lin, {Chung Jung} and Liu, {Hung Yu} and Chi, {Nai Fang} and Hsu, {Li Chi} and Tang, {Chih Wei} and Guo, {Wan Yuo} and Luo, {Chao Bao} and Lai, {Yen Jun} and Lee, {I. Hui}",

note = "Publisher Copyright: Copyright {\textcopyright} 2020, the Chinese Medical Association.",

year = "2021",

month = jan,

doi = "10.1097/JCMA.0000000000000434",

language = "English",

volume = "84",

pages = "61--67",

journal = "Journal of the Chinese Medical Association",

issn = "1726-4901",

publisher = "Elsevier Taiwan LLC",

number = "1",

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TY - JOUR

T1 - Quantitative CT angiography predicts large artery occlusion types and successful thrombectomy in acute ischemic stroke

AU - Chien, Chun

AU - Lin, Chun Jen

AU - Chang, Feng Chi

AU - Chung, Chih Ping

AU - Lin, Chung Jung

AU - Liu, Hung Yu

AU - Chi, Nai Fang

AU - Hsu, Li Chi

AU - Tang, Chih Wei

AU - Guo, Wan Yuo

AU - Luo, Chao Bao

AU - Lai, Yen Jun

AU - Lee, I. Hui

PY - 2021/1

Y1 - 2021/1

N2 - Background: Clinical and radiological outcomes of endovascular thrombectomy (EVT) are related to etiologies of large vessel occlusion (LVO) in acute stroke. However, preprocedural computed tomography angiography (CTA) or CT perfusion imaging can hardly distinguish embolic occlusion from atherosclerotic occlusion. We hypothesized that quantitative multiphase CTA (mCTA) of LVO may predict occlusion types and thrombectomy outcome. Methods: We retrospectively evaluated the consecutive stroke patients who had undergone mCTA and EVT <6 hours of onset at two independent medical centers. The intra-arterial radiodensities of Hounsfield unit (HU) were measured to examine the HUdistal/proximal ratio using receiver operating characteristic curve analysis. The derived cut-off value was re-examined in an independent cohort. Results: In the derivation cohort (n = 102), 81 patients (79.4%) were embolic occlusion without severe residual intracranial atherosclerotic stenosis (ICAS[−]) and 21 patients were atherosclerosis-related occlusion (ICAS[+]) based on digital subtraction angiography (DSA). The optimal cut-off to predict embolic occlusion was HU ratio <0.6 measured at 2 mm from the occlusion site (maximum area under the curve = 0.87; sensitivity 96%; specificity 81%). This cut-off also independently predicted successful recanalization using stent-retrievers and/or contact aspiration (modified Treatment in Cerebral Ischemia score ≥2b; p = 0.002) after adjusting for age, atrial fibrillation, and collateral circulation score, but not predicted favorable outcome at 3 months post stroke. Importantly, in the validation cohort (n = 95, 80% embolic occlusion), this HU ratio cut-off similarly predicted occlusion types and recanalization outcome, respectively. Conclusion: The mCTA-based quantitative radiodensities of acute LVO provides preprocedural predictive values of DSA-determined occlusion types and thrombectomy outcomes.

AB - Background: Clinical and radiological outcomes of endovascular thrombectomy (EVT) are related to etiologies of large vessel occlusion (LVO) in acute stroke. However, preprocedural computed tomography angiography (CTA) or CT perfusion imaging can hardly distinguish embolic occlusion from atherosclerotic occlusion. We hypothesized that quantitative multiphase CTA (mCTA) of LVO may predict occlusion types and thrombectomy outcome. Methods: We retrospectively evaluated the consecutive stroke patients who had undergone mCTA and EVT <6 hours of onset at two independent medical centers. The intra-arterial radiodensities of Hounsfield unit (HU) were measured to examine the HUdistal/proximal ratio using receiver operating characteristic curve analysis. The derived cut-off value was re-examined in an independent cohort. Results: In the derivation cohort (n = 102), 81 patients (79.4%) were embolic occlusion without severe residual intracranial atherosclerotic stenosis (ICAS[−]) and 21 patients were atherosclerosis-related occlusion (ICAS[+]) based on digital subtraction angiography (DSA). The optimal cut-off to predict embolic occlusion was HU ratio <0.6 measured at 2 mm from the occlusion site (maximum area under the curve = 0.87; sensitivity 96%; specificity 81%). This cut-off also independently predicted successful recanalization using stent-retrievers and/or contact aspiration (modified Treatment in Cerebral Ischemia score ≥2b; p = 0.002) after adjusting for age, atrial fibrillation, and collateral circulation score, but not predicted favorable outcome at 3 months post stroke. Importantly, in the validation cohort (n = 95, 80% embolic occlusion), this HU ratio cut-off similarly predicted occlusion types and recanalization outcome, respectively. Conclusion: The mCTA-based quantitative radiodensities of acute LVO provides preprocedural predictive values of DSA-determined occlusion types and thrombectomy outcomes.

KW - Computed tomography angiography

KW - Intracranial arteriosclerosis

KW - Stroke

KW - Thrombectomy

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U2 - 10.1097/JCMA.0000000000000434

DO - 10.1097/JCMA.0000000000000434

M3 - Article

C2 - 32956106

AN - SCOPUS:85099428744

SN - 1726-4901

VL - 84

SP - 61

EP - 67

JO - Journal of the Chinese Medical Association

JF - Journal of the Chinese Medical Association

IS - 1

ER -

Quantitative CT angiography predicts large artery occlusion types and successful thrombectomy in acute ischemic stroke

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