Automated ASPECTS in Acute Ischemic Stroke: A Comparative Analysis with CT Perfusion ADULT BRAIN
BACKGROUND AND PURPOSE: Automated ASPECTS has the potential of reducing interobserver variability in the determination of early ischemic changes. We aimed to assess the performance of an automated ASPECTS software against the assessment of a neuroradiologist in a comparative analysis with concurrent CTP-based CBV ASPECTS. MATERIALS AND METHODS: Patients with anterior circulation stroke who had baseline NCCT and CTP and underwent successful mechanical thrombectomy were included. NCCT-ASPECTS was assessed by 2 neuroradiologists, and discrepancies were resolved by consensus. CTP-CBV ASPECTS was assessed by a different neuroradiologist. Automated ASPECTS was provided by Brainomix software. ASPECTS was dichotomized (ASPECTS ≥6 or 6 or ≤6 hours). RESULTS: A total of 58 patients were included. The interobserver agreement for NCCT ASPECTS was moderate ( = 0.48) and marginally improved ( = 0.64) for dichotomized data. Automated ASPECTS showed excellent agreement with consensus reads ( = 0.84) and CTP-CBV ASPECTS ( = 0.84). Intraclass correlation coefficients for ASPECTS across all 3 groups were 0.84 (95% CI, 0.76–0.90, raw scores) and 0.94 (95% CI, 0.91–0.96, dichotomized scores). Automated scores were comparable with consensus reads and CTP-CBV ASPECTS in patients when grouped on the basis of time from symptom onset (>6 or ≤6 hours). There was significant (P
Publication date: February 2020Source: The Annals of Thoracic Surgery, Volume 109, Issue 2Author(s): Elizabeth L. Norton, Xiaoting Wu, Linda Farhat, Karen M. Kim, Himanshu J. Patel, G. Michael Deeb, Bo YangBackgroundIt is controversial if extension of aortic dissection into arch branches should be an indication for replacement of the arch and its branches in acute type A aortic dissection.MethodsFrom 2008 to April 2018, 399 patients underwent open repair for an acute type A aortic dissection, and 190 patients had known innominate and/or left common carotid artery dissection without malperfusion syndrome, including no arch ...
ConclusionA positive DWI-SWI mismatch is an indicator of the ischemic penumbra and a predictor of infarct expansion if left untreated.
Authors: Sheen JJ, Kim YW Abstract Three randomized control trials (RCTs), published in 2013, investigated efficacy of mechanical thrombectomy in large vessel occlusions and did not show better results compared to intravenous (IV) recombinant tissue-type plasminogen activator (tPA) alone. However, most clinicians treating stroke consider mechanical thrombectomy as the standard treatment rather than using IV tPA alone. This paradigm shift was based on five RCTs investigating efficacy of mechanical thrombectomy in acute ischemic stroke conducted from 2010 to 2015. They demonstrated that mechanical thrombectomy was ef...
CONCLUSIONS: The collateral-based imaging paradigm using multiphase CTA compares well with CTP in selecting patients for endovascular thrombectomy in the late time window.
Conclusions: There is no justification for the use of reperfusion procedures in acute ischaemic stroke in the anterior circulation in patients with initially unfavourable multimodal computed tomography scores. PMID: 31908703 [PubMed]
Low-dose aspirin reduces the frequency of adverse vascular events in those at increased risk of occlusive cardiovascular disease (CVD). People who benefit include those: with a history of myocardial infarction, ischaemic stroke, unstable or stable angina, peripheral arterial disease, or atrial fibrillation (1). The pathophysiology of CVD risk contributes to cognitive decline through multiple pathways that include cerebral hypo-perfusion, hypoxia, hippocampal atrophy, emboli, or infarcts (2,3). However, the value of aspirin use in prevention of cognitive impairment remains uncertain since results relating to the influence o...
ConclusionAdding CTP and/or a delayed-phase CTA to NCCT with arterial-phase CTA improves the decision-maker ’s confidence level and creates a trend towards a lower threshold for mechanical thrombectomy.
Conclusions: At least 27 pediatric neurocritical care centers use transcranial Doppler during clinical care. In the majority of centers, studies are performed and interpreted by credentialed personnel, and findings are used to guide clinical management. Further studies are needed to standardize these practices.
Computed tomography perfusion (CTP) is increasingly used to determine treatment eligibility for acute ischemic stroke patients. Automated postprocessing of raw CTP data is routinely used, but it can fail. In reviewing 176 consecutive acute ischemic stroke patients, failures occurred in 20 patients (11%) during automated postprocessing by the RAPID software. Failures were caused by motion (n = 11, 73%), streak artifacts (n = 2, 13%), and poor contrast bolus arrival (n = 2, 13%). Stroke physicians should review CTP results with care before they are being integrated in their decision-making process.
We present the case of a 70-year-old man with multiple acute/subacute bilateral infarcts. The patient was found to have stenosis of the left internal carotid artery secondary to herpes zoster ophthalmicus vasculopathy, with involvement of the left proximal middle and anterior cerebral arteries. Angiographic studies also revealed A1 segment aplasia of the right anterior cerebral artery (ACA), thus indicating dependence on the left-sided circulation for perfusion of the bilateral ACA vascular territory.