Jang-Hyun Baek1, Byung Moon Kim2, Joonsang Yoo1, Hyo Suk Nam1, Young Dae Kim1, Dong Joon Kim1, Ji Hoe Heo1, Oh Young Bang1. 1. From the Department of Neurology, National Medical Center, Seoul, Korea (J.-H.B.); Departments of Radiology (B.M.K., D.J.K.) and Neurology (J.-H.B., J.Y., H.S.N., Y.D.K., J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Korea (O.Y.B.); and Department of Neurology, Keimyung University College of Medicine, Daegu, Korea (J.Y.). 2. From the Department of Neurology, National Medical Center, Seoul, Korea (J.-H.B.); Departments of Radiology (B.M.K., D.J.K.) and Neurology (J.-H.B., J.Y., H.S.N., Y.D.K., J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Korea (O.Y.B.); and Department of Neurology, Keimyung University College of Medicine, Daegu, Korea (J.Y.). bmoon21@hanmail.net.
Abstract
BACKGROUND AND PURPOSE: We investigated whether occlusion type identified with computed tomography angiography (CTA-determined occlusion type) could predict endovascular treatment success using stent retriever (SR) thrombectomy. METHODS: Consecutive patients with stroke who underwent CTA and then endovascular treatment for intracranial large artery occlusion were retrospectively reviewed. CTA-determined occlusion type was classified into truncal-type occlusion or branching-site occlusion and compared with digital subtraction angiography-determined occlusion type during endovascular treatment. Three rapidly- and readily-assessable pre-procedural findings (CTA-determined occlusion type, atrial fibrillation, and hyperdense artery sign), which may infer occlusion pathomechanism (embolic versus nonembolic) before endovascular treatment, were evaluated for association with SR success along with stroke risk factors and laboratory results. In addition, the predictive power of the 3 pre-procedural findings for SR success was compared with receiver operating characteristic curve analyses. RESULTS: A total of 238 patients (mean age, 70.0 years; male patients, 52.9%) were included in this study. CTA-determined occlusion type corresponded adequately with digital subtraction angiography-determined occlusion type (P=0.453). Atrial fibrillation (odds ratio, 2.66; 95% confidence interval, 1.25-5.66) and CTA-determined branching-site occlusion (odds ratio, 8.20; confidence interval, 3.45-19.5) were independent predictors for SR success. For predicting SR success, the area under the receiver operating characteristic curve value for CTA-determined branching-site occlusion (0.695) was significantly greater than atrial fibrillation (0.594; P=0.038) and hyperdense artery sign (0.603; P=0.023). CONCLUSIONS: CTA-determined branching-site occlusion was significantly associated with SR success. Furthermore, among the 3 rapidly- and readily-assessable pre-procedural findings, CTA-determined branching-site occlusion had the greatest predictive power for SR success.
BACKGROUND AND PURPOSE: We investigated whether occlusion type identified with computed tomography angiography (CTA-determined occlusion type) could predict endovascular treatment success using stent retriever (SR) thrombectomy. METHODS: Consecutive patients with stroke who underwent CTA and then endovascular treatment for intracranial large artery occlusion were retrospectively reviewed. CTA-determined occlusion type was classified into truncal-type occlusion or branching-site occlusion and compared with digital subtraction angiography-determined occlusion type during endovascular treatment. Three rapidly- and readily-assessable pre-procedural findings (CTA-determined occlusion type, atrial fibrillation, and hyperdense artery sign), which may infer occlusion pathomechanism (embolic versus nonembolic) before endovascular treatment, were evaluated for association with SR success along with stroke risk factors and laboratory results. In addition, the predictive power of the 3 pre-procedural findings for SR success was compared with receiver operating characteristic curve analyses. RESULTS: A total of 238 patients (mean age, 70.0 years; male patients, 52.9%) were included in this study. CTA-determined occlusion type corresponded adequately with digital subtraction angiography-determined occlusion type (P=0.453). Atrial fibrillation (odds ratio, 2.66; 95% confidence interval, 1.25-5.66) and CTA-determined branching-site occlusion (odds ratio, 8.20; confidence interval, 3.45-19.5) were independent predictors for SR success. For predicting SR success, the area under the receiver operating characteristic curve value for CTA-determined branching-site occlusion (0.695) was significantly greater than atrial fibrillation (0.594; P=0.038) and hyperdense artery sign (0.603; P=0.023). CONCLUSIONS: CTA-determined branching-site occlusion was significantly associated with SR success. Furthermore, among the 3 rapidly- and readily-assessable pre-procedural findings, CTA-determined branching-site occlusion had the greatest predictive power for SR success.
Authors: Seungyon Koh; Ji Hyun Park; Bumhee Park; Mun Hee Choi; Sung Eun Lee; Jin Soo Lee; Ji Man Hong; Seong-Joon Lee Journal: J Clin Med Date: 2020-11-22 Impact factor: 4.241
Authors: Jin Soo Lee; Seong-Joon Lee; Ji Man Hong; Francisco José Arruda Mont Alverne; Fabricio Oliveira Lima; Raul G Nogueira Journal: J Stroke Date: 2022-01-31 Impact factor: 6.967