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Intraluminal Middle Cerebral Artery Occlusion MCAO Model for Ischemic Stroke with Laser Doppler Flowmetry Guidance in Mice
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CT perfusion for predicting intracranial atherosclerotic middle cerebral artery occlusion

Zigao Wang1,2, Abudoukeyoumu Yasheng2, Yifeng Ling1

  • 1Department of Neurology and Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China.

Frontiers in Neurology
|July 8, 2024
PubMed

Insights

Baseline computed tomography perfusion (CTP) can identify intracranial atherosclerotic stenosis (ICAS) causing middle cerebral artery occlusion (MCAO). A slow core volume growth rate on CTP predicts ICAS-related MCAO, aiding treatment decisions before thrombectomy.

Area of Science:

  • Neurology
  • Radiology
  • Vascular Medicine

Background:

  • Distinguishing between intracranial atherosclerotic stenosis (ICAS) and embolism is crucial for treating acute middle cerebral artery occlusion (MCAO).
  • Baseline computed tomography perfusion (CTP) may offer insights into the etiology of MCAO.
  • Optimal treatment selection for MCAO, particularly before endovascular thrombectomy, hinges on accurate etiological diagnosis.

Purpose of the Study:

  • To determine if baseline CTP characteristics can differentiate ICAS-related MCAO from embolic MCAO.
  • To identify predictors of ICAS in acute MCAO using CTP data.
  • To assess the diagnostic performance of CTP parameters in distinguishing MCAO causes.

Main Methods:

  • Retrospective analysis of clinical and CTP data from 97 patients with acute MCAO undergoing endovascular thrombectomy.
  • Definition of core volume growth rate as core volume on CTP divided by onset to CTP time.
  • Multivariate logistic analysis and receiver operating characteristic (ROC) curve analysis to identify predictors and evaluate diagnostic performance.

Main Results:

  • ICAS-related MCAO (32%) differed significantly from embolic MCAO (68%) in age, sex, smoking history, atrial fibrillation prevalence, NIHSS score, core volume, and core location.
  • Core volume growth rate was identified as an independent predictor of ICAS-related MCAO (aOR 0.46, p=0.01).
  • A core volume growth rate cutoff of 2.5 mL/h demonstrated 81% sensitivity and 80% specificity for predicting ICAS-related MCAO.

Conclusions:

  • A slow core volume growth rate on baseline CTP is a significant predictor of ICAS-related MCAO.
  • CTP analysis can aid in differentiating the causes of MCAO, informing treatment strategies.
  • Prospective studies are recommended to validate these findings in larger cohorts.
Abstract

Keywords:
computed tomography perfusioncore volume growth rateembolismintracranial atherosclerotic stenosismiddle cerebral artery occlusion

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