Comparative Evaluation of Imaging Modalities for Eligibility in Endovascular Treatment of Delayed Onset Acute Anterior Circulation Ischemic Stroke in Siriraj Hospital: A Retrospective Analysis
Issued Date
2024-01-01
Resource Type
eISSN
22288082
Scopus ID
2-s2.0-85204153055
Journal Title
Siriraj Medical Journal
Volume
76
Issue
9
Start Page
573
End Page
580
Rights Holder(s)
SCOPUS
Bibliographic Citation
Siriraj Medical Journal Vol.76 No.9 (2024) , 573-580
Suggested Citation
Chudapongse R., Sangpetngam B., Chankaew E., Aurboonyawat T., Churojana A., Withayasuk P. Comparative Evaluation of Imaging Modalities for Eligibility in Endovascular Treatment of Delayed Onset Acute Anterior Circulation Ischemic Stroke in Siriraj Hospital: A Retrospective Analysis. Siriraj Medical Journal Vol.76 No.9 (2024) , 573-580. 580. doi:10.33192/smj.v76i9.268564 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/101317
Title
Comparative Evaluation of Imaging Modalities for Eligibility in Endovascular Treatment of Delayed Onset Acute Anterior Circulation Ischemic Stroke in Siriraj Hospital: A Retrospective Analysis
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Abstract
Objective: The goal of this study is to evaluate the consistency between computed tomographic perfusion (CTP) according to the endovascular therapy following imaging evaluation for ischemic stroke (DEFUSE-3) criteria and other standard computed tomography (CT) imaging modalities, such as multi-phase CT angiography (MCTA) and unenhanced computed tomography (UECT), in assessing patient eligibility for EVT as determined by neurointerventionists evaluations. Materials and Methods: This retrospective analysis included 64 patients with anterior circulation stroke and onset between 6 to 12 hours or unknown onset. Two neuro-interventionalists independently reviewed images and assessed eligibility for EVT based on the Alberta stroke program early CT score (ASPECTS) derived from UECT and collateral score obtained from MCTA. The results were then compared to CTP, utilizing the DEFUSE-3 criteria. Results: Out of the 64 cases analyzed (mean age: 69 years ± 13.9 [SD]), 61 met DEFUSE-3 criteria for EVT by CTP, while 54 were deemed eligible based on an ASPECTS ≥ 6 and collateral score ≥ 3. Agreement between the modalities was moderate (Kappa coefficient score 0.4). When patients with ASPECTS score < 6 were excluded, concordance improved to perfect (Kappa coefficient score 1.0). Hence, concordance was significantly associated with ASPECTS scores ≥ 6 (P < 0.001). Conclusion: In patients experiencing anterior circulation stroke with onset between 6 to 12 hours or unknown onset, excluding an ASPECTS score of 6 or higher, MCTA and UECT proved to be reliable for assessing endovascular treatment eligibility. These modalities may serve as substitutes for CTP and offer support in the clinical decision-making process.