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Predictive Value of Computed Tomography Angiography-Determined Occlusion Type in Stent Retriever Thrombectomy
Jang-Hyun Baek1, Byung Moon Kim2, Joonsang Yoo1
1From 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.).
Insights
Computed tomography angiography (CTA)-determined branching-site occlusion predicts successful stent retriever (SR) thrombectomy for stroke. This CTA finding offers greater predictive power for SR success than atrial fibrillation or hyperdense artery sign.
Area of Science:
- Neurology
- Interventional Radiology
- Medical Imaging
Background:
- Intracranial large artery occlusion is a critical cause of stroke.
- Effective endovascular treatment relies on accurate pre-procedural assessment.
- Computed tomography angiography (CTA) is a key imaging modality for stroke evaluation.
Purpose of the Study:
- To determine if CTA-determined occlusion type can predict the success of endovascular treatment using stent retrievers (SR).
- To compare the predictive power of CTA-determined occlusion type with other pre-procedural findings for SR success.
Main Methods:
- Retrospective review of 238 stroke patients undergoing CTA and SR thrombectomy.
- Classification of CTA-determined occlusion types (truncal vs. branching-site).
- Evaluation of pre-procedural findings (occlusion type, atrial fibrillation, hyperdense artery sign) for association with SR success using receiver operating characteristic curve analysis.
Main Results:
- CTA-determined occlusion type correlated well with digital subtraction angiography findings.
- Atrial fibrillation (OR 2.66) and CTA-determined branching-site occlusion (OR 8.20) were independent predictors of SR success.
- CTA-determined branching-site occlusion demonstrated the highest predictive power (AUC 0.695) for SR success compared to atrial fibrillation (AUC 0.594) and hyperdense artery sign (AUC 0.603).
Conclusions:
- CTA-determined branching-site occlusion is a significant predictor of successful stent retriever thrombectomy.
- CTA-derived occlusion type is a valuable, readily assessable tool for predicting endovascular treatment outcomes in stroke patients.
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.
