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

Why the fuck are you predicting outcome rather than delivering 100% recovery outcome?  Everyone associated with this would be fired under my leadership. Totally fucking useless. Someone has to lay down the law on stroke research, we are getting nowhere close to the only goal in stoke, 100% recovery for all.

 

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will ream me out for making them look bad by being truthful , I look forward to that day.

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

 

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

Clinical Neuroradiology (2020)Cite this article

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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.