Two-way comparison of brain perfusion image processing software for patients with acute ischemic strokes in real-world.

PURPOSE: Perfusion imaging generates multimaps of ischemic tissues and is a proven decision-making tool in patients with acute ischemic stroke. However, the reliability of perfusion post-processing outcomes has been debated, given disparate results of various software applications, especially for patients with small ischemic core volume. This study was undertaken to compare ischemic volume estimates determined by imSTROKE (a software with new imaging protocol) and RAPID computer applications, respectively. METHODS: A total of 611 patients qualified for study, each having met inclusion and exclusion criteria of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN trial). Subjects were examined by computed tomography perfusion (CTP) imaging (n = 349) or perfusion-weighted (PWI) and diffusion-weighted (DWI) imaging (n = 262). Ischemic volumes estimated by imSTROKE and RAPID applications were then compared. We used Bland-Altman analysis and intraclass correlation coefficients (ICCs) to ascertain agreement between applications. Accuracies of estimated core infarct and penumbra volumes were tested at specific thresholds (core: 25 mL, 50 mL, and 70 mL; penumbra: 45 mL, 90 mL, and 125 mL). RESULTS: Median core infarct volumes by imSTROKE and RAPID were 29.18 mL and 29.53 mL, respectively (ICC = 0.9880, 95% confidence interval [CI]: 0.9860-0.9898). Median penumbra volumes by imSTROKE and RAPID were 68.20 mL and 68.55 mL, respectively (ICC = 0.9885, 95% CI: 0.9865-0.9902). CONCLUSION: In estimating core infarct and penumbra volumes, imSTROKE and RAPID applications showed high-level agreement. For patients with small ischemic core volume, compared with RAPID, imSTROKE may have better sensitivity.

Mechanical thrombectomy via chronic occluded proximal artery for the endovascular treatment of acute ischemic stroke patients with large vessel occlusion.

BACKGROUND: Mechanical thrombectomy (MT) can significantly improve the prognosis of acute ischemic stroke patients with large vessel occlusion. However, for patients with chronic occluded proximal artery, therapeutical strategies are limited because the endovascular route for MT is not readily accessible. METHODS: Here, we introduce a safe and effective MT procedure via a chronic occluded proximal artery. We conducted a retrospective study of seven patients with acute ischemic stroke due to large artery occlusion (AIS-LVO) who underwent MT via a chronic occluded proximal artery for endovascular treatment. We analyzed the technical procedure of the MT and the clinical outcomes of these patients. RESULTS: The distal thrombus was successfully removed in all patients by opening the occluded proximal artery, thus achieving revascularization with a Thrombolysis in Cerebral Infarction (TICI) of 2b/3. The average time from arterial puncture to reperfusion was 171.14 ± 36.56 min. Three patients had a good modified Rankin scale (mRS) score (0-2) at discharge. Among 4 patients with anterior circulation stroke, 2 recovered completely, 1 had anomic aphasia, and 1 had hemiplegia. Among 3 patients with posterior circulation stroke, 1 recovered completely, 1 had locked-in syndrome, and 1 was comatose. Four patients had good functional prognoses. CONCLUSIONS: Mechanical thrombectomy procedure via a chronic occluded proximal artery can be used in patients with well-established collateral compensatory vessels. It is safe and effective in improving the prognosis of patients. It can be used as a remedial treatment strategy for patients with AIS-LVO.