PURPOSE: Several new techniques have emerged for detecting anterior circulation large vessel occlusion by quantifying relative vessel density including RAPID-CTA, potentially allowing for faster triage and decreased time to mechanical thrombectomy. We present our one-year experience on positive predictive value of RAPID-CTA for the detection of large vessel occlusion in patients presenting with stroke symptoms and its effect on treatment time and clinical outcomes. MATERIALS AND METHODS: Three hundred and ten patients presenting with stroke symptoms with relative vessel density <60% on RAPID-CTA were included (average age 70 years, 145 male, 165 female). Examinations were considered positive if there was evidence of large vessel occlusion or high grade stenosis. Computed tomography angiography to groin puncture time was calculated during one-year time intervals before and after RAPID-CTA installation. Ninety-day Modified Rankin Scale scores were obtained for patients in each cohort. RESULTS: Of the 310 patients, 270 had large vessel occlusion or high grade stenosis (87% positive predictive value), with 161 having large vessel occlusion. Using 45% relative vessel density threshold, 129/161 large vessel occlusion were detected (80% sensitivity) and 163/172 examinations were positive (95% positive predictive value). Computed tomography angiography to groin puncture time was significantly lower after deployment of RAPID-CTA (93 min vs 68 min, p<0.05). Average 90 day modified Rankin Scale score was lower in the RAPID-CTA group with a higher percentage of patients with functional independence, although the data was not statistically significant. CONCLUSION: RAPID-CTA had high positive predictive value for large vessel occlusion with a 45% relative vessel density threshold, which could facilitate active worklist reprioritization. Time to treatment was significantly lower and clinical outcomes were improved after deployment of RAPID-CTA.
PURPOSE: Several new techniques have emerged for detecting anterior circulation large vessel occlusion by quantifying relative vessel density including RAPID-CTA, potentially allowing for faster triage and decreased time to mechanical thrombectomy. We present our one-year experience on positive predictive value of RAPID-CTA for the detection of large vessel occlusion in patients presenting with stroke symptoms and its effect on treatment time and clinical outcomes. MATERIALS AND METHODS: Three hundred and ten patients presenting with stroke symptoms with relative vessel density <60% on RAPID-CTA were included (average age 70 years, 145 male, 165 female). Examinations were considered positive if there was evidence of large vessel occlusion or high grade stenosis. Computed tomography angiography to groin puncture time was calculated during one-year time intervals before and after RAPID-CTA installation. Ninety-day Modified Rankin Scale scores were obtained for patients in each cohort. RESULTS: Of the 310 patients, 270 had large vessel occlusion or high grade stenosis (87% positive predictive value), with 161 having large vessel occlusion. Using 45% relative vessel density threshold, 129/161 large vessel occlusion were detected (80% sensitivity) and 163/172 examinations were positive (95% positive predictive value). Computed tomography angiography to groin puncture time was significantly lower after deployment of RAPID-CTA (93 min vs 68 min, p<0.05). Average 90 day modified Rankin Scale score was lower in the RAPID-CTA group with a higher percentage of patients with functional independence, although the data was not statistically significant. CONCLUSION: RAPID-CTA had high positive predictive value for large vessel occlusion with a 45% relative vessel density threshold, which could facilitate active worklist reprioritization. Time to treatment was significantly lower and clinical outcomes were improved after deployment of RAPID-CTA.
Authors: Gregory W Albers; Michael P Marks; Stephanie Kemp; Soren Christensen; Jenny P Tsai; Santiago Ortega-Gutierrez; Ryan A McTaggart; Michel T Torbey; May Kim-Tenser; Thabele Leslie-Mazwi; Amrou Sarraj; Scott E Kasner; Sameer A Ansari; Sharon D Yeatts; Scott Hamilton; Michael Mlynash; Jeremy J Heit; Greg Zaharchuk; Sun Kim; Janice Carrozzella; Yuko Y Palesch; Andrew M Demchuk; Roland Bammer; Philip W Lavori; Joseph P Broderick; Maarten G Lansberg Journal: N Engl J Med Date: 2018-01-24 Impact factor: 91.245
Authors: Raul G Nogueira; Ashutosh P Jadhav; Diogo C Haussen; Alain Bonafe; Ronald F Budzik; Parita Bhuva; Dileep R Yavagal; Marc Ribo; Christophe Cognard; Ricardo A Hanel; Cathy A Sila; Ameer E Hassan; Monica Millan; Elad I Levy; Peter Mitchell; Michael Chen; Joey D English; Qaisar A Shah; Frank L Silver; Vitor M Pereira; Brijesh P Mehta; Blaise W Baxter; Michael G Abraham; Pedro Cardona; Erol Veznedaroglu; Frank R Hellinger; Lei Feng; Jawad F Kirmani; Demetrius K Lopes; Brian T Jankowitz; Michael R Frankel; Vincent Costalat; Nirav A Vora; Albert J Yoo; Amer M Malik; Anthony J Furlan; Marta Rubiera; Amin Aghaebrahim; Jean-Marc Olivot; Wondwossen G Tekle; Ryan Shields; Todd Graves; Roger J Lewis; Wade S Smith; David S Liebeskind; Jeffrey L Saver; Tudor G Jovin Journal: N Engl J Med Date: 2017-11-11 Impact factor: 91.245
Authors: Mayank Goyal; Andrew M Demchuk; Bijoy K Menon; Muneer Eesa; Jeremy L Rempel; John Thornton; Daniel Roy; Tudor G Jovin; Robert A Willinsky; Biggya L Sapkota; Dar Dowlatshahi; Donald F Frei; Noreen R Kamal; Walter J Montanera; Alexandre Y Poppe; Karla J Ryckborst; Frank L Silver; Ashfaq Shuaib; Donatella Tampieri; David Williams; Oh Young Bang; Blaise W Baxter; Paul A Burns; Hana Choe; Ji-Hoe Heo; Christine A Holmstedt; Brian Jankowitz; Michael Kelly; Guillermo Linares; Jennifer L Mandzia; Jai Shankar; Sung-Il Sohn; Richard H Swartz; Philip A Barber; Shelagh B Coutts; Eric E Smith; William F Morrish; Alain Weill; Suresh Subramaniam; Alim P Mitha; John H Wong; Mark W Lowerison; Tolulope T Sajobi; Michael D Hill Journal: N Engl J Med Date: 2015-02-11 Impact factor: 91.245
Authors: Romain Bourcier; Mayank Goyal; David S Liebeskind; Keith W Muir; Hubert Desal; Adnan H Siddiqui; Diederik W J Dippel; Charles B Majoie; Wim H van Zwam; Tudor G Jovin; Elad I Levy; Peter J Mitchell; Olvert A Berkhemer; Stephen M Davis; Imad Derraz; Geoffrey A Donnan; Andrew M Demchuk; Robert J van Oostenbrugge; Michael Kelly; Yvo B Roos; Reza Jahan; Aad van der Lugt; Marieke Sprengers; Stephane Velasco; Geert J Lycklama À Nijeholt; Wagih Ben Hassen; Paul Burns; Scott Brown; Emmanuel Chabert; Timo Krings; Hana Choe; Christian Weimar; Bruce C V Campbell; Gary A Ford; Marc Ribo; Phil White; Geoffrey C Cloud; Luis San Roman; Antoni Davalos; Olivier Naggara; Michael D Hill; Serge Bracard Journal: JAMA Neurol Date: 2019-04-01 Impact factor: 18.302