Site and Rate of Occlusive Disease in Cervicocerebral Arteries: A CT Angiography Study of 2209 Patients with Acute Ischemic Stroke

Rotzinger, David C.; Mosimann, Pascal J.; Meuli, Reto; Maeder, Philippe; Michel, Patrik

doi:10.3174/ajnr.a5123

Cited by 14 publications

(6 citation statements)

References 29 publications

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“…The MT rate of 11.6% is comparable to large observational studies [ 11 ]. The bridging IVT rate of over 60% did not differ between the CT- and MRI-guided group.…”

Section: Discussionsupporting

confidence: 79%

CT- versus MRI-Based Imaging for Thrombolysis and Mechanical Thrombectomy in Ischemic Stroke: Analysis from the Austrian Stroke Registry

Krebs¹,

Posekany²,

Pilz³

et al. 2022

J Stroke

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Background and Purpose It is unclear whether a particular stroke imaging modality offers an advantage for the acute stroke treatment. The aim of this study was to compare procedure times, efficacy and safety of thrombolysis and/or thrombectomy based on computed tomography (CT) versus magnetic resonance imaging (MRI) acute stroke imaging.Methods Data of stroke patients who received intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT) were extracted from a nationwide, prospective stroke unit registry and categorized according to initial imaging modality. Study endpoints included procedure times, symptomatic intracerebral hemorrhage (sICH), early neurological improvement, 3-month functional outcome by modified Rankin Scale (mRS) and mortality.Results Stroke patients (n=16,799) treated with IVT and 2,248 treated with MT were included. MRI-guided patients (n=2,599) were younger, had less comorbidities and higher rates of strokes with unknown onset as compared to CT-guided patients. In patients treated with IVT, no differences were observed regarding the rates of functional outcome by mRS 0–1 (adjusted odds ratio [OR], 0.87; 95% confidence interval [CI], 0.71 to 1.05), sICH (adjusted OR, 0.82; 95% CI, 0.61 to 1.08), and mortality (adjusted OR, 0.88; 95% CI, 0.63 to 1.22). Patients undergoing MT selected by MRI as compared to CT showed equal rates of functional outcome by mRS 0–2 (adjusted OR, 0.87; 95% CI, 0.65 to 1.16), sICH (adjusted OR, 0.9; 95% CI, 0.51 to 1.69), and mortality (adjusted OR, 0.62; 95% CI, 0.35 to 1.09). MRI-guided patients showed a significant intrahospital delay of about 20 minutes in both the IVT and the MT group.Conclusions This large non-randomized comparison study indicates that CT- and MRI-guided patient selection for IVT/MT may perform equally well in terms of functional outcome and safety.

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“…The MT rate of 11.6% is comparable to large observational studies [ 11 ]. The bridging IVT rate of over 60% did not differ between the CT- and MRI-guided group.…”

Section: Discussionsupporting

confidence: 79%

CT- versus MRI-Based Imaging for Thrombolysis and Mechanical Thrombectomy in Ischemic Stroke: Analysis from the Austrian Stroke Registry

Krebs¹,

Posekany²,

Pilz³

et al. 2022

J Stroke

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“…Meanwhile, most of the intracranial arterial stensis occurs in the trunk of the artery. Of note, previous studies also showed that intracranial arteriostenosis preferably occurs in the midlower segment of the basilar artery, internal carotid siphon, and the trunks before bifurcation in the M1 segment of the middle cerebral artery (22,23). Baek et al demonstrated that the occlusion types (truncaltype occlusion and branching-site occlusion), were independent predictors for ICAS and embolism in intracranial large artery occlusion related AIS (16).…”

Section: Discussionmentioning

confidence: 97%

Association Between Occlusion Type and Etiology of Acute Intracranial Large Artery Occlusion

Huang¹,

Hong²,

Xu³

et al. 2020

Front. Neurol.

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Objective: To investigate the diagnostic efficiency of truncal-type occlusion and branching-site occlusion in determining the etiology of intracranial large artery occlusion related acute ischemic stroke (AIS). Methods: Patients with intracranial large artery occlusion related AIS who received stent retriever (SR) thrombectomy from November 2014 to June 2019 were included in the study. All patients underwent angiography before SR thrombectomy, which was used to evaluate the occlusion type. Differences in the distribution of occlusion types in intracranial atherosclerosis (ICAS) and embolism were assessed, and the diagnostic indicators, including the area under the ROC curve (AUC), sensitivity, and specificity were calculated. Results: Of the 115 AIS patients with intracranial large artery occlusion, 42 were classified as having ICAS, and 73 having an embolism. In the ICAS group, branching-site occlusion was responsible for 3 (7%) cases and truncal-type occlusion for 39 (93%) cases, while in the embolism group, branching-site occlusion was responsible for 66 (90%) cases and truncal-type occlusion for 7 (10%) cases; the difference was statistically significant (all P < 0.01). The AUC for ICAS predicted by truncal-type occlusion was 0.916, with a sensitivity of 92.86%, and specificity of 90.41%. Conclusion: Truncal-type occlusion showed a high predictability of ICAS. Determine the etiology of intracranial large artery occlusion related AIS before SR thrombectomy may be most helpful in setting up optimal endovascular treatment strategies.

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“…Extracranial or intracranial (i.e. carotid artery to the furthest intracranial segments) occlusion as absent contrast medium filling of the examined arterial segment 12 . Excellent outcome defined as mRS 0–2 at 90-day follow-up.…”

Section: Methodsmentioning

confidence: 99%

Classification and management strategy of spontaneous carotid artery dissection

Zhou,

Li,

Jiao

et al. 2023

Preprint

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Background and Purpose—Spontaneous carotid artery dissections (sCAD) are the main cause of stroke in young people. There is still a lack of clinical classification to guide the management of sCAD. We reviewed our experience with 179 sCAD patients and proposed a new classification for sCAD with prognostic and therapeutic significance. Methods—This is a retrospective review of prospectively collected data from June 2018 to June 2023 of sCAD patients treated at a large tertiary academic institution in an urban city in China. Depending on the degree of luminal narrowing and pseudoaneurysm formation on imaging, sCAD was classified into four types. Type IV dissections were divided into type IVA and type IVB dissections according to the presence of intracranial occlusion. Results—A total of 179 patients and 197 dissected arteries met the inclusion criteria. More than two-thirds of type I dissections are completely recanalized after antithrombotic therapy, and only one case (1.8%) had recurrent ischemic stroke. A total of 38 % of type II dissections and 73% of type III dissections received endovascular treatment (EVT) for persistent flow-limited dissections, enlargement of pseudoaneurysm, or aggravation of clinical symptoms despite antithrombotic therapy. Type IV dissections are more likely to lead to the occurrence of ischemic stroke, and presented with more severe symptoms. About 33% of type IVB dissections received emergent intervention due to intracranial occlusion or aggravation of symptoms after medical treatment. Conclusions—This study proposes a novel and more comprehensive classification method and management strategy for sCAD. Antithrombotic therapy is beneficial to reduce the risk of recurrent stroke for stable sCAD like type I. Non-emergent EVT can be an alternative therapeutic approach for patients who meet indications as in type II to IVA. Urgent procedure with neurovascular intervention might be needed in those with type IVB SCAD. The short-term results of EVT for sCAD are encouraging, and long-term device-related and functional outcome should be elucidated.

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Site and Rate of Occlusive Disease in Cervicocerebral Arteries: A CT Angiography Study of 2209 Patients with Acute Ischemic Stroke

Cited by 14 publications

References 29 publications

CT- versus MRI-Based Imaging for Thrombolysis and Mechanical Thrombectomy in Ischemic Stroke: Analysis from the Austrian Stroke Registry

CT- versus MRI-Based Imaging for Thrombolysis and Mechanical Thrombectomy in Ischemic Stroke: Analysis from the Austrian Stroke Registry

Association Between Occlusion Type and Etiology of Acute Intracranial Large Artery Occlusion

Classification and management strategy of spontaneous carotid artery dissection

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