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Utility of Time-Variant Multiphase CTA Color Maps in Outcome Prediction for Acute Ischemic Stroke Due to Anterior Circulation Large Vessel Occlusion

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Abstract

Background

Multiphase CTA (mCTA) is an established tool for endovascular treatment decision-making and outcome prediction in acute ischemic stroke, but its interpretation requires some degree of experience. We aimed to determine whether mCTA-based prediction of clinical outcome and final infarct volume can be improved by assessing collateral status on time-variant mCTA color maps rather than using a conventional mCTA display format.

Methods

Patients from the PRove-IT cohort study with anterior circulation large vessel occlusion were included in this study. Collateral status was assessed with a three-point scale using the conventional display format. Collateral extent and filling dynamics were then graded on a three-point scale using time-variant mCTA color-maps (FastStroke, GE Healthcare, Milwaukee, WI, USA). Multivariable logistic regression was performed to determine the association of conventional collateral score, color-coded collateral extent and color-coded collateral filling dynamics with good clinical outcome and final infarct volume (volume below vs. above median infarct volume in the study sample).

Results

A total of 285 patients were included in the analysis and 53% (152/285) of the patients achieved a good outcome. Median infarct volume on follow-up was 12.6 ml. Color-coded collateral extent was significantly associated with good outcome (adjusted odds ratio [adjOR] 0.53, 95% confidence interval [CI]:0.36–0.77) while color-coded collateral filling dynamics (adjOR 1.30 [95%CI:0.88–1.95]) and conventional collateral scoring (adjOR 0.72 [95%C:0.48–1.08]) were not. Both color-coded collateral extent (adjOR 2.67 [95%CI:1.80–4.00]) and conventional collateral scoring (adjOR 1.84 [95%CI:1.21–2.79]) were significantly associated with follow-up infarct volume, while color-coded collateral filling dynamics were not (adjOR 1.21 [95%CI:0.83–1.78]).

Conclusion

In this study, collateral extent assessment on time-variant mCTA maps improved prediction of good outcome and has similar value in predicting follow-up infarct volume compared to conventional mCTA collateral grading.

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References

  1. Saver JL. Time is brain-quantified. Stroke. 2006;37:263–6.

    Article  PubMed  Google Scholar 

  2. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019;50:e344-418. Erratum in: Stroke. 2019;50:e440-1.

    Article  PubMed  Google Scholar 

  3. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, Dávalos A, Majoie CB, van der Lugt A, de Miquel MA, Donnan GA, Roos YB, Bonafe A, Jahan R, Diener HC, van den Berg LA, Levy EI, Berkhemer OA, Pereira VM, Rempel J, Millán M, Davis SM, Roy D, Thornton J, Román LS, Ribó M, Beumer D, Stouch B, Brown S, Campbell BC, van Oostenbrugge RJ, Saver JL, Hill MD, Jovin TG; HERMES collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387:1723–31.

    Article  PubMed  Google Scholar 

  4. Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, McTaggart RA, Torbey MT, Kim-Tenser M, Leslie-Mazwi T, Sarraj A, Kasner SE, Ansari SA, Yeatts SD, Hamilton S, Mlynash M, Heit JJ, Zaharchuk G, Kim S, Carrozzella J, Palesch YY, Demchuk AM, Bammer R, Lavori PW, Broderick JP, Lansberg MG; DEFUSE 3 Investigators. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med. 2018;378:708–18.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, Yan B, Dowling RJ, Parsons MW, Oxley TJ, Wu TY, Brooks M, Simpson MA, Miteff F, Levi CR, Krause M, Harrington TJ, Faulder KC, Steinfort BS, Priglinger M, Ang T, Scroop R, Barber PA, McGuinness B, Wijeratne T, Phan TG, Chong W, Chandra RV, Bladin CF, Badve M, Rice H, de Villiers L, Ma H, Desmond PM, Donnan GA, Davis SM; EXTEND-IA Investigators. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372:1009–18.

    Article  CAS  PubMed  Google Scholar 

  6. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, Roy D, Jovin TG, Willinsky RA, Sapkota BL, Dowlatshahi D, Frei DF, Kamal NR, Montanera WJ, Poppe AY, Ryckborst KJ, Silver FL, Shuaib A, Tampieri D, Williams D, Bang OY, Baxter BW, Burns PA, Choe H, Heo JH, Holmstedt CA, Jankowitz B, Kelly M, Linares G, Mandzia JL, Shankar J, Sohn SI, Swartz RH, Barber PA, Coutts SB, Smith EE, Morrish WF, Weill A, Subramaniam S, Mitha AP, Wong JH, Lowerison MW, Sajobi TT, Hill MD; ESCAPE Trial Investigators. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372:1019–30.

    Article  CAS  PubMed  Google Scholar 

  7. Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, Yavagal DR, Ribo M, Cognard C, Hanel RA, Sila CA, Hassan AE, Millan M, Levy EI, Mitchell P, Chen M, English JD, Shah QA, Silver FL, Pereira VM, Mehta BP, Baxter BW, Abraham MG, Cardona P, Veznedaroglu E, Hellinger FR, Feng L, Kirmani JF, Lopes DK, Jankowitz BT, Frankel MR, Costalat V, Vora NA, Yoo AJ, Malik AM, Furlan AJ, Rubiera M, Aghaebrahim A, Olivot JM, Tekle WG, Shields R, Graves T, Lewis RJ, Smith WS, Liebeskind DS, Saver JL, Jovin TG; DAWN Trial Investigators. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med. 2018;378:11–21.

    Article  PubMed  Google Scholar 

  8. Menon BK, d’Esterre CD, Qazi EM, Almekhlafi M, Hahn L, Demchuk AM, Goyal M. Multiphase CT Angiography: A New Tool for the Imaging Triage of Patients with Acute Ischemic Stroke. Radiology. 2015;275:510–20.

    Article  PubMed  Google Scholar 

  9. Ospel JM, Volny O, Qiu W, Najm M, Kashani N, Goyal M, Menon BK. Displaying Multiphase CT Angiography Using a Time-Variant Color Map: Practical Considerations and Potential Applications in Patients with Acute Stroke. AJNR Am J Neuroradiol. 2020;41:200–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Ospel JMVO, Qiu W, Najm M, Hafeez M, Abdalrahman S, Fainardi E, Rubiera M, Khaw A, Shankar J, Hill M, Almekhlafi M, Demchuk A, Goyal M, Menon BK. CT perfusion vs. multiphase CTA in endovascular treatment decision-making for acute ischemic stroke. 2020.

    Google Scholar 

  11. Almekhlafi M, Ospel JM, Saposnik G, Kashani N, Demchuk A, Hill MD, Goyal M, Menon BK. Endovascular Treatment Decisions in Patients with M2 Segment MCA Occlusions. AJNR Am J Neuroradiol. 2020;41:280–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Hill MD, Goyal M, Menon BK, Nogueira RG, McTaggart RA, Demchuk AM, Poppe AY, Buck BH, Field TS, Dowlatshahi D, van Adel BA, Swartz RH, Shah RA, Sauvageau E, Zerna C, Ospel JM, Joshi M, Almekhlafi MA, Ryckborst KJ, Lowerison MW, Heard K, Garman D, Haussen D, Cutting SM, Coutts SB, Roy D, Rempel JL, Rohr AC, Iancu D, Sahlas DJ, Yu AYX, Devlin TG, Hanel RA, Puetz V, Silver FL, Campbell BCV, Chapot R, Teitelbaum J, Mandzia JL, Kleinig TJ, Turkel-Parrella D, Heck D, Kelly ME, Bharatha A, Bang OY, Jadhav A, Gupta R, Frei DF, Tarpley JW, McDougall CG, Holmin S, Rha JH, Puri AS, Camden MC, Thomalla G, Choe H, Phillips SJ, Schindler JL, Thornton J, Nagel S, Heo JH, Sohn SI, Psychogios MN, Budzik RF, Starkman S, Martin CO, Burns PA, Murphy S, Lopez GA, English J, Tymianski M; ESCAPE-NA1 Investigators. Efficacy and safety of nerinetide for the treatment of acute ischaemic stroke (ESCAPE-NA1): a multicentre, double-blind, randomised controlled trial. Lancet. 2020;395:878–87.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Tan IY, Demchuk AM, Hopyan J, Zhang L, Gladstone D, Wong K, Martin M, Symons SP, Fox AJ, Aviv RI. CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct. AJNR Am J Neuroradiol. 2009;30:525–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. d’Esterre CD, Trivedi A, Pordeli P, Boesen M, Patil S, Hwan Ahn S, Najm M, Fainardi E, Shankar JJ, Rubiera M, Almekhlafi MA, Mandzia J, Khaw AV, Barber P, Coutts S, Hill MD, Demchuk AM, Sajobi T, Forkert ND, Goyal M, Lee TY, Menon BK. Regional Comparison of Multiphase Computed Tomographic Angiography and Computed Tomographic Perfusion for Prediction of Tissue Fate in Ischemic Stroke. Stroke. 2017;48:939–45.

    Article  PubMed  Google Scholar 

  15. Grunwald IQ, Kulikovski J, Reith W, Gerry S, Namias R, Politi M, Papanagiotou P, Essig M, Mathur S, Joly O, Hussain K, Wagner V, Shah S, Harston G, Vlahovic J, Walter S, Podlasek A, Fassbender K. Collateral Automation for Triage in Stroke: Evaluating Automated Scoring of Collaterals in Acute Stroke on Computed Tomography Scans. Cerebrovasc Dis. 2019;47:217–22.

    Article  PubMed  Google Scholar 

  16. Rodger M, Ramsay T, Fergusson D. Diagnostic randomized controlled trials: the final frontier. Trials. 2012;13:137.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors are most grateful to all enrolling sites.

Funding

The authors report no funding for this study.

Author information

Authors and Affiliations

  1. Department of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 1403 29th St. NW, T2N2T9, Calgary, AB, Canada

    Johanna M Ospel, Petra Cimflova, Wu Qiu, Moiz Hafeez, Arnuv Mayank, Mohamed Najm, Nima Kashani, Mohammed A Almekhlafi, Bijoy K Menon & Mayank Goyal

  2. Department of Radiology, University Hospital of Basel, Basel, Switzerland

    Johanna M Ospel

  3. Department of Medical Imaging, St. Anne’s University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic

    Petra Cimflova

  4. International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic

    Petra Cimflova

  5. Czech National Centre for Evidence-Based Healthcare and Knowledge Translation, Faculty of Medicine, Masaryk University, Brno, Czech Republic

    Ondrej Volny

  6. Department of Medical Biophysics, University of Western Ontario, London, Canada

    Kevin Chung

  7. Department of Radiology, University of Calgary, Calgary, Canada

    Nima Kashani, Mohammed A Almekhlafi, Bijoy K Menon & Mayank Goyal

Authors
  1. Johanna M Ospel
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  2. Petra Cimflova
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  10. Mohammed A Almekhlafi
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  11. Bijoy K Menon
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  12. Mayank Goyal
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Corresponding author

Correspondence to Mayank Goyal.

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Conflict of interest

M. Goyal is a consultant for Medtronic, Stryker, Microvention, GE Healthcare, Mentice. J.M. Ospel is supported by the University of Basel Research Foundation, Julia Bangerter-Rhyner Foundation and Freiwillige Akademische Gesellschaft Basel. B. Menon holds a patent on systems of triage in acute stroke and stock ownership in Circle Neurovascular, Inc, and reports funding from the Canadian Institute for Health Research. B. Menon is also a medical consultant for Circle NVI. P. Cimflova, O. Volny, W. Qiu, M. Hafeez, A. Mayank, M. Najm, K. Chung, N. Kashani, M.A. Almekhlafi declare that they have no competing interests.

Ethical standards

Consent from the local ethics committee was obtained for this study. All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. All study participants gave informed consent prior to enrolment.

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62_2020_958_MOESM1_ESM.docx

Supplementary tables I & II: Association of conventional and color-map based collateral grade and final infarct volume stratified by follow-up imaging modality

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Ospel, J.M., Cimflova, P., Volny, O. et al. Utility of Time-Variant Multiphase CTA Color Maps in Outcome Prediction for Acute Ischemic Stroke Due to Anterior Circulation Large Vessel Occlusion. Clin Neuroradiol 31, 783–790 (2021). https://doi.org/10.1007/s00062-020-00958-3

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