Dataset Information

Posterior communicating and anterior communicating arteries on pre-thrombectomy computed tomography scans are associated with good outcomes irrespective of leptomeningeal collateral status.

ABSTRACT:

Background

Collateral blood flow is known to be an important factor that sustains the penumbra during acute stroke. We looked at both the leptomeningeal collateral circulation and the presence of anterior and posterior communicating arteries to determine the factors associated with good outcomes and mortality.

Methods

We included all patients with acute ischaemic stroke in the anterior circulation, who underwent thrombectomy with the same thrombectomy device from 2013 to 2016. We assessed the leptomeningeal circulation by the Tan, Miteff and Maas validated scoring systems on pre-treatment computed tomographic angiography scans and looked at collateral flow through anterior and posterior communicating arteries. The results were good functional outcomes at 3 months (modified Rankin scale 0-2) and mortality.

Results

A total of 147 consecutive acute stroke patients treated with the Embotrap device were included with a median National Institutes of Health stroke scale of 15 (range 2-26). On multivariate analysis only younger age (odds ratio (OR) 0.96/year, 95% confidence interval (CI) 0.94-0.99, P = 0.026), lower National Institutes of Health stroke scale score (OR 0.87/point, 95% CI 0.80-0.93, P < 0.001), number of attempts (OR 0.80/attempt, 95% CI 0.65-0.99, P = 0.043) and the presence of a patent anterior communicating artery (OR 14.03, 95% CI 1.42-139.07, P = 0.024) were associated with good functional outcomes. The number of attempts (OR 1.66/attempt, 95% CI 1.21-2.29, P = 0.002) was significantly associated with mortality and the presence of a patent posterior communicating artery (OR 0.098, 95% CI 0.016-0.59, P = 0.011) was inversely associated with mortality.

Conclusions

Our study shows that the presence of anterior and posterior communicating arteries is significantly associated with good functional outcomes and reduced mortality, respectively, independent of the leptomeningeal circulation status.

SUBMITTER: Yeo LL

PROVIDER: S-EPMC6607609 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Publications

Posterior communicating and anterior communicating arteries on pre-thrombectomy computed tomography scans are associated with good outcomes irrespective of leptomeningeal collateral status.

Yeo Leonard Ll LL Andersson Tommy T Holmberg Åke Å Mpotsaris Anastasios A Söderman Michael M Holmin Staffan S Bhogal Pervinder P Cunli Yang Y Gopinathan Anil A Tan Benjamin Yq BY Gontu Vamsi V Kolloch Jens J KuntzeSöderqvist Åsa Å Brouwer Patrick A PA Cornelissen Sandra S

Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences 20190225 4

<h4>Background</h4>Collateral blood flow is known to be an important factor that sustains the penumbra during acute stroke. We looked at both the leptomeningeal collateral circulation and the presence of anterior and posterior communicating arteries to determine the factors associated with good outcomes and mortality.<h4>Methods</h4>We included all patients with acute ischaemic stroke in the anterior circulation, who underwent thrombectomy with the same thrombectomy device from 2013 to 2016. We ...[more]

PMID: 30803332

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Project description:BackgroundCoronary computed tomography angiography (CTA) has been increasingly used to identify the degree of coronary artery stenosis and plaque lesions in vessels. This study evaluated the feasibility of using high-definition (HD) scanning with high-level deep learning image reconstruction (DLIR-H) to improve the image quality and spatial resolution when imaging calcified plaques and stents in coronary CTA as compared to the standard definition (SD) reconstruction mode with adaptive statistical iterative reconstruction-V (ASIR-V).MethodsA total of 34 patients (age 63.3±10.9 years; 55.88% female) with calcified plaques and/or stents who underwent coronary CTA in HD-mode were included in this study. Images were reconstructed with SD-ASIR-V, HD-ASIR-V, and HD-DLIR-H. Subjective image quality with image noise and clarity of vessels, calcifications, and stented lumens was evaluated by 2 radiologists using a 5-point scale. The kappa (κ) test was used to analyze the interobserver agreement. Objective image quality with image noise, signal-to-noise-ratio (SNR), and contrast-to-noise-ratio (CNR) was measured and compared. Image spatial resolution and beam-hardening artifacts (BHAs) were also evaluated using the calcification diameter and CT numbers in 3 points along the stented lumen (inside, at the proximal and distal ends just outside stent).ResultsThere were 45 calcified plaques and 4 coronary stents. HD-DLIR-H images had the highest overall image quality score (4.50±0.63) with the lowest image noise (22.59±3.59 HU) and the highest SNR (18.30±4.88) and CNR (26.56±6.33), followed by SD-ASIR-V50% image quality score (4.06±2.49), image noise (35.02±8.09 HU), SNR (12.77±1.59), CNR(15.67±1.92) and HD-ASIR-V50% image quality score (3.90±0.64), image noise (57.7±12.03 HU), SNR (8.16±1.86), CNR (10.01±2.39). HD-DLIR-H images also had the smallest calcification diameter measurement (2.36±1.58 mm), followed by HD-ASIR-V50% (3.46±2.07 mm) and SD-ASIR-V50% (4.06±2.49 mm). HD-DLIR-H images had the closest CT value measurements for the 3 points along the stented lumen, indicating much less BHA. Interobserver agreement on the image quality assessment was good to excellent (HD-DLIR-H: κ value =0.783; HD-ASIR-V50%: κ value =0.789; SD-ASIR-V50%: κ value =0.671).ConclusionsCoronary CTA with HD scan mode and DLIR-H significantly improves the spatial resolution for displaying calcifications and in-stent lumens while simultaneously reducing image noise.

Dataset Information

Posterior communicating and anterior communicating arteries on pre-thrombectomy computed tomography scans are associated with good outcomes irrespective of leptomeningeal collateral status.

Background

Methods

Results

Conclusions

Publications

Posterior communicating and anterior communicating arteries on pre-thrombectomy computed tomography scans are associated with good outcomes irrespective of leptomeningeal collateral status.

Similar Datasets

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