Automated Cerebral Infarct Volume Measurement in Follow-up Noncontrast CT Scans of Patients with Acute Ischemic Stroke

Boers, Anna M. M.; Marquering, Henk A.; Jochem, Jerzy; Besselink, N.J.; Berkhemer, Olvert A.; Lugt, Aad van der; Beenen, Ludo F. M.; Majoie, Charles B. L. M.

doi:10.3174/ajnr.a3463

Cited by 89 publications

(70 citation statements)

References 17 publications

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“…The mTICI score is a 5-point scale, which ranges from 0 (no reperfusion) to 3 (complete antegrade reperfusion of the previously ischemic territory, with the absence of visualized occlusion in all distal branches). 27,28 Interaction between BP and IAT on safety parameters was also tested. Safety parameters included death, hemicraniectomy, SICH, and progression of ischemic stroke.…”

Section: Outcome and Safety Measuresmentioning

confidence: 99%

Baseline Blood Pressure Effect on the Benefit and Safety of Intra-Arterial Treatment in MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands)

Mulder¹,

Ergezen²,

Lingsma³

et al. 2017

Stroke

113

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Background and Purpose— High blood pressure (BP) is associated with poor outcome and the occurrence of symptomatic intracranial hemorrhage in acute ischemic stroke. Whether BP influences the benefit or safety of intra-arterial treatment (IAT) is not known. We aimed to assess the relation of BP with functional outcome, occurrence of symptomatic intracranial hemorrhage and effect of IAT. Methods— This is a post hoc analysis of the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands). BP was measured at baseline, before IAT or stroke unit admission. We estimated the association of baseline BP with the score on the modified Rankin Scale at 90 days and safety parameters with ordinal and logistic regression analysis. Effect of BP on the effect of IAT was tested with multiplicative interaction terms. Results— Systolic BP (SBP) had the best correlation with functional outcome. This correlation was U-shaped; both low and high baseline SBP were associated with poor functional outcome. Higher SBP was associated with symptomatic intracranial hemorrhage (adjusted odds ratio, 1.25 for every 10 mm Hg higher SBP [95% confidence interval, 1.09–1.44]). Between SBP and IAT, there was no interaction for functional outcome, symptomatic intracranial hemorrhage, or other safety parameters; the absolute benefit of IAT was evident for the whole SBP range. The same was found for diastolic BP. Conclusions— BP does not affect the benefit or safety of IAT in patients with acute ischemic stroke caused by proximal intracranial vessel occlusion. Our data provide no arguments to withhold or delay IAT based on BP. Clinical Trial Registration— URL: http://www.isrctn.com . Unique identifier: ISRCTN10888758.

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Section: Outcome and Safety Measuresmentioning

confidence: 99%

Baseline Blood Pressure Effect on the Benefit and Safety of Intra-Arterial Treatment in MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands)

Mulder¹,

Ergezen²,

Lingsma³

et al. 2017

Stroke

113

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“…7,8 Inclusion criteria for this substudy were thin-slice NCCT and CTA (<2.5 mm) performed on the same scanner within 30 minutes. Clinical outcome such as modified Rankin Scale (mRS), modified Arterial Occlusive Lesion (mAOL) score, Thrombolysis in Cerebral Infarction perfusion scale (TICI) score, and final infarct volume (FIV), 9 and baseline clinical characteristics (such as age, sex, National Institutes of Health Stroke Scale [NIHSS] score, time from onset to intravenous [IV] recombinant tissue-type plasminogen activator [r-tPA] treatment, time from onset to groin puncture, occlusion site, and atrial fibrillation) were collected during the execution of the trial. Of 248 consecutive patients with thin-slice NCCT and CTA, 10 were excluded because the time between NCCT and CTA imaging exceeded 30 minutes, 3 because CTA was performed before NCCT imaging, 3 because CTA and NCCT were performed on a different scanner, 39 because of imaging quality limitations, including movement artifacts (25), noisy NCCT image (10), incomplete region of interest (3), and CTA triggered too early or too late (1).…”

Section: Patient Selectionmentioning

confidence: 99%

Thrombus Permeability Is Associated With Improved Functional Outcome and Recanalization in Patients With Ischemic Stroke

Santos

Marquering

Blanken

et al. 2016

Stroke

111

100

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T reatment of patients with acute ischemic stroke (AIS) is aimed at reopening occluded arteries and reestablishment of intracranial perfusion. Determining pivotal characteristics about the occluding thrombus using available imaging has the potential to improve patient's diagnostics and prognostics.Background and Purpose-Preclinical studies showed that thrombi can be permeable and may, therefore, allow for residual blood flow in occluded arteries of patients having acute ischemic stroke. This perviousness may increase tissue oxygenation, improve thrombus dissolution, and augment intra-arterial treatment success. We hypothesize that the combination of computed tomographic angiography and noncontrast computed tomography imaging allows measurement of contrast agent penetrating a permeable thrombus, and it is associated with improved outcome. Methods-Thrombus and contralateral artery attenuations in noncontrast computed tomography and computed tomographic angiography images were measured in 184 Multicenter Randomized Clinical trial of Endovascular treatment of acute ischemic stroke in the Netherlands (MR CLEAN) patients with thin-slice images. Two quantitative estimators of the thrombus permeability were introduced: computed tomographic angiography attenuation increase (Δ) and thrombus void fraction (ε). Patients were dichotomized as having a pervious or impervious thrombus and associated with outcome, recanalization, and final infarct volume. Results-Patients with Δ≥10.9 HU (n=81 [44%]) and ε≥6.5% (n=77 [42%]) were classified as having a pervious thrombus.These patients were 3.2 (95% confidence interval, 1.7-6.4) times more likely to have a favorable outcome, and 2.5 (95% confidence interval, 1.3-4.8) times more likely to recanalyze, for Δ based classification, and similarly for ε. These odds ratios were independent from intravenous or intra-arterial treatment. Final infarct volume was negatively correlated with both perviousness estimates (correlation coefficient, −0.39 for Δ and −0.40 for ε). Conclusions-This

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“…Secondary outcome measures were the following: the absence of an intracranial occlusion on follow-up CTA and final infarct volume on follow-up NCCT. 19 For the patients who underwent successful IAT reperfusion, modified Thrombolysis in Cerebral Infarction 2B or 3 20 was also used as a secondary outcome measure. For dichotomized outcome measures, univariable logistic regression analysis was performed, and the association was presented as an OR.…”

mentioning

confidence: 99%

Value of Thrombus CT Characteristics in Patients with Acute Ischemic Stroke

Borst

Berkhemer

Santos

et al. 2017

AJNR Am J Neuroradiol

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Automated Cerebral Infarct Volume Measurement in Follow-up Noncontrast CT Scans of Patients with Acute Ischemic Stroke

Cited by 89 publications

References 17 publications

Baseline Blood Pressure Effect on the Benefit and Safety of Intra-Arterial Treatment in MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands)

Baseline Blood Pressure Effect on the Benefit and Safety of Intra-Arterial Treatment in MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands)

Thrombus Permeability Is Associated With Improved Functional Outcome and Recanalization in Patients With Ischemic Stroke

Value of Thrombus CT Characteristics in Patients with Acute Ischemic Stroke

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