Automated detection of arterial landmarks and vascular occlusions in patients with acute stroke receiving digital...

Digital subtraction angiography (DSA) is the gold-standard method of assessing arterial blood flow and blockages prior to endovascular thrombectomy.

To detect anatomical features and arterial occlusions with DSA using artificial intelligence techniques.

We included 82 patients with acute ischemic stroke who underwent DSA imaging and whose carotid terminus was visible in at least one run. Two neurointerventionalists labeled the carotid location (when visible) and vascular occlusions on 382 total individual DSA runs. For detecting the carotid terminus, positive and negative image patches (either containing or not containing the internal carotid artery terminus) were extracted in a 1:1 ratio. Two convolutional neural network architectures (ResNet-50 pretrained on ImageNet and ResNet-50 trained from scratch) were evaluated. Area under the curve (AUC) of the receiver operating characteristic and pixel distance from the ground truth were calculated. The same training and analysis methods were used for detecting arterial occlusions.

The ResNet-50 trained from scratch most accurately detected the carotid terminus (AUC 0.998 (95% CI 0.997 to 0.999), p<0.00001) and arterial occlusions (AUC 0.973 (95% CI 0.971 to 0.975), p<0.0001). Average pixel distances from ground truth for carotid terminus and occlusion localization were 63±45 and 98±84, corresponding to approximately 1.26±0.90 cm and 1.96±1.68 cm for a standard angiographic field-of-view.

These results may serve as an unbiased standard for clinical stroke trials, as optimal standardization would be useful for core laboratories in endovascular thrombectomy studies, and also expedite decision-making during DSA-based procedures.