Open AccessAutomated CT Perfusion Prediction of Large Vessel Acute Stroke from Intracranial Atherosclerotic Disease
Author(s) -
Diogo C Haussen,
Mehdi Bouslama,
Seena Dehkharghani,
Jonathan A Grossberg,
Nicolas Bianchi,
Meredith Bowen,
Michael Frankel,
Raul G Nogueira
Publication year - 2018
Publication title -
interventional neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.07
H-Index - 5
eISSN - 1664-9737
pISSN - 1664-5545
DOI - 10.1159/000487335
Subject(s) - icad , medicine , cardiology , stroke (engine) , perfusion , occlusion , mechanical engineering , biochemistry , chemistry , engineering , gene
Background and Purpose: We have observed that large vessel occlusion acute strokes (LVOS) due to intracranial atherosclerotic disease (ICAD) present with more benign CT perfusion (CTP) profiles, which we presume to potentially represent enhanced collateralization compared to embolic LVOS. We aim to determine if CTP profiles can predict ICAD in LVOS. Methods: Retrospective review of a prospectively collected interventional stroke database from September 2010 to March 2015. Patients with intracranial ICA/MCA-M1/M2 occlusions and CTP were dichotomized into ICAD versus non-ICAD etiologies. Ischemic core (relative cerebral blood flow 4 s, Tmax > 6 s, and Tmax > 10 s absolute lesions, and a higher ratio of Tmax > 4 s/Tmax > 6 s volumes (median 2 [1.6–2.3] vs. 1.6 [1.4–2.0]; p = 0.02). A Tmax > 4 s/Tmax > 6 s ratio ≥2 showed specificity = 73%/sensitivity = 52% for ICAD and was observed in 47.6% of ICAD versus 26.1% of non-ICAD patients (p = 0.07). Clinical outcomes were comparable amongst groups. Multivariate logistic regression revealed that Tmax > 4 s/Tmax > 6 s ratio ≥2 (OR 3.75, 95% CI 1.05–13.14, p = 0.04), higher LDL cholesterol (OR 1.1, 95% CI 1.01–1.03, p = 0.01), and higher systolic pressure (OR 1.03, 95% CI 1.01–1.04, p = 0.01) were independently associated with ICAD. Conclusion: An automated CTP Tmax > 4 s/Tmax > 6 s ratio ≥2 profile was found independently associated with underlying ICAD LVOS.