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Effect of stroke thrombolysis predicted by distal vessel occlusion detection

Wolfgang G Kunz1, Matthias P Fabritius2, Wieland H Sommer2

  • 1From the Departments of Radiology (W.G.K., M.P.F., W.H.S., L.T.R., B.O.S., F.G.M., B.E.-W., M.F.R., K.M.T.), Neurology (C.H., P.S.), Nuclear Medicine (W.P.F.), and Neuroradiology (F.D.), University Hospital, LMU Munich; and the Institute of Diagnostic and Interventional Radiology (F.G.M., K.M.T.), University Medical Center Rostock, Germany. wolfgang.kunz@med.lmu.de.

Neurology
|April 22, 2018
PubMed

Insights

In ischemic stroke patients with negative CT angiography, detecting distal occlusions with CT perfusion postprocessing (waveletCTA) predicts a better response to intravenous thrombolysis (IVT). This finding aids in selecting appropriate stroke treatments.

Area of Science:

  • Neuroimaging
  • Stroke Medicine
  • Radiology

Background:

  • CT angiography (CTA) can miss distal occlusions in ischemic stroke.
  • CT perfusion (CTP) postprocessing offers enhanced detection of these occlusions.
  • Identifying distal occlusions is crucial for guiding reperfusion therapy.

Purpose of the Study:

  • To evaluate the predictive value of waveletCTA for intravenous thrombolysis (IVT) treatment effect.
  • To assess if waveletCTA-detected distal occlusions improve outcomes in ischemic stroke patients with negative CTA.
  • To determine the role of advanced CTP analysis in stroke management.

Main Methods:

  • Retrospective analysis of 1,851 patients undergoing CTP.
  • Inclusion of patients with significant cerebral blood flow deficit, negative CTA, and confirmed infarction.
  • Utilized waveletCTA for distal occlusion detection and assessed morphologic and functional outcomes post-IVT.

Main Results:

  • Among 107 patients with negative CTA, 58% had distal occlusions detected by waveletCTA.
  • In IVT-treated patients, waveletCTA-detected occlusions independently predicted favorable morphologic response (p=0.001) and functional outcomes (p=0.039 for mRS, p=0.013 for ∆NIHSS).
  • No outcome prediction was observed in patients receiving supportive care.

Conclusions:

  • WaveletCTA-detected distal vessel occlusions are significant predictors of IVT treatment response in ischemic stroke patients with initially negative CTA.
  • This advanced imaging technique can refine treatment selection for intravenous thrombolysis.
  • Enhanced CTP analysis improves the diagnostic yield in challenging stroke cases.
Abstract

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