Advertisement

Identifying large vessel occlusion using the hyperdense artery sign in patients treated with mechanical thrombectomy

  • Author Footnotes
    1 Takuya Saito, MD; Kohan Hospital, Tel: +81-22-248-2131
    Takuya Saito
    Correspondence
    Corresponding author.
    Footnotes
    1 Takuya Saito, MD; Kohan Hospital, Tel: +81-22-248-2131
    Affiliations
    Department of Stroke Neurology, Kohnan Hospital, 4-20-1, Nagamachi-minami, Taihaku-ku, Sendai, Miyagi 982-8523, Japan
    Search for articles by this author
  • Author Footnotes
    2 Ryo Itabashi, MD, PhD: Iwate Medical University, Tel: +81-19-613-7111
    Ryo Itabashi
    Footnotes
    2 Ryo Itabashi, MD, PhD: Iwate Medical University, Tel: +81-19-613-7111
    Affiliations
    Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba, Japan
    Search for articles by this author
  • Author Footnotes
    3 Kazutaka Uchida, MD, PhD: Hyogo Medical University, Tel: +81-79-845-6111
    Kazutaka Uchida
    Footnotes
    3 Kazutaka Uchida, MD, PhD: Hyogo Medical University, Tel: +81-79-845-6111
    Affiliations
    Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
    Search for articles by this author
  • Author Footnotes
    4 Yuichi Kawabata, MD: Kohan Hospital, Tel: +81-22-248-2131
    Yuichi Kawabata
    Footnotes
    4 Yuichi Kawabata, MD: Kohan Hospital, Tel: +81-22-248-2131
    Affiliations
    Department of Stroke Neurology, Kohnan Hospital, 4-20-1, Nagamachi-minami, Taihaku-ku, Sendai, Miyagi 982-8523, Japan
    Search for articles by this author
  • Author Footnotes
    5 Shota Igasaki, MD: Kohan Hospital, Tel: +81-22-248-2131
    Shota Igasaki
    Footnotes
    5 Shota Igasaki, MD: Kohan Hospital, Tel: +81-22-248-2131
    Affiliations
    Department of Stroke Neurology, Kohnan Hospital, 4-20-1, Nagamachi-minami, Taihaku-ku, Sendai, Miyagi 982-8523, Japan
    Search for articles by this author
  • Author Footnotes
    6 Kazuhiko Sato, MD: Tohoku Medical and Pharmaceutical University, Tel: +81-22-234-4181
    Kazuhiko Sato
    Footnotes
    6 Kazuhiko Sato, MD: Tohoku Medical and Pharmaceutical University, Tel: +81-22-234-4181
    Affiliations
    Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
    Search for articles by this author
  • Author Footnotes
    7 Tomohiro Chiba, A.S.: Kohan Hospital, Tel: +81-22-248-2131
    Tomohiro Chiba
    Footnotes
    7 Tomohiro Chiba, A.S.: Kohan Hospital, Tel: +81-22-248-2131
    Affiliations
    Division of Radiology, Kohnan Hospital, Sendai, Japan
    Search for articles by this author
  • Author Footnotes
    8 Takeshi Morimoto, MD, PhD: Hyogo Medical University, Tel: +81-79-845-6111
    Takeshi Morimoto
    Footnotes
    8 Takeshi Morimoto, MD, PhD: Hyogo Medical University, Tel: +81-79-845-6111
    Affiliations
    Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
    Search for articles by this author
  • Author Footnotes
    9 Yukako Yazawa, MD, PhD: Kohan Hospital, Tel: +81-22-248-2131
    Yukako Yazawa
    Footnotes
    9 Yukako Yazawa, MD, PhD: Kohan Hospital, Tel: +81-22-248-2131
    Affiliations
    Department of Stroke Neurology, Kohnan Hospital, 4-20-1, Nagamachi-minami, Taihaku-ku, Sendai, Miyagi 982-8523, Japan
    Search for articles by this author
  • Author Footnotes
    1 Takuya Saito, MD; Kohan Hospital, Tel: +81-22-248-2131
    2 Ryo Itabashi, MD, PhD: Iwate Medical University, Tel: +81-19-613-7111
    3 Kazutaka Uchida, MD, PhD: Hyogo Medical University, Tel: +81-79-845-6111
    4 Yuichi Kawabata, MD: Kohan Hospital, Tel: +81-22-248-2131
    5 Shota Igasaki, MD: Kohan Hospital, Tel: +81-22-248-2131
    6 Kazuhiko Sato, MD: Tohoku Medical and Pharmaceutical University, Tel: +81-22-234-4181
    7 Tomohiro Chiba, A.S.: Kohan Hospital, Tel: +81-22-248-2131
    8 Takeshi Morimoto, MD, PhD: Hyogo Medical University, Tel: +81-79-845-6111
    9 Yukako Yazawa, MD, PhD: Kohan Hospital, Tel: +81-22-248-2131

      Abstract

      Objectives

      The hyperdense artery sign on non-contrast computed tomography-reconstructed images is useful for identifying large vessel occlusion in acute ischemic stroke. This study aimed to assess its efficacy in patients with large vessel occlusion treated with mechanical thrombectomy.

      Materials and methods

      : This retrospective and prospective single-centered study from June 2019 to May 2021 evaluated the use of non-contrast computed tomography-reconstructed images for detecting hyperdense artery sign to identify large vessel occlusion from June 2020 to May 2021. We registered consecutive potential candidates for mechanical thrombectomy due to suspected stroke and assessed the accuracy of hyperdense artery sign on non-contrast computed tomography-reconstructed images for large vessel occlusion in the hyperacute setting. Non-contrast computed tomography images were reconstructed into maximum intensity projection images with iterative reconstruction algorithms to detect hyperdense artery signs. We compared the door-to-puncture time and functional outcome at 90 days before and after employing non-contrast computed tomography-reconstructed images in patients with large vessel occlusion treated with mechanical thrombectomy.

      Results

      The cohort included 82 patients, wherein 47 were treated with mechanical thrombectomy. The sensitivity (96%) and specificity (94%) of hyperdense artery sign on non-contrast computed tomography-reconstructed images for large vessel occlusion were performed. The door-to-puncture time was significantly shortened after using non-contrast computed tomography-reconstructed images (49 versus 28 min, p = 0.001), but the functional outcome at 90 days remained unchanged.

      Conclusions

      Non-contrast computed tomography-reconstructed images, as a vascular imaging tool for mechanical thrombectomy, can reduce workflow time in hospitals by identifying large vessel occlusion with high sensitivity and specificity.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Goyal M
        • Menon BK
        • van Zwam WH
        • et al.
        Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials.
        Lancet. 2016; 387: 1723-1731
        • Powers WJ
        • Rabinstein AA
        • Ackerson T
        • et al.
        Guidelines for the early management of patients With acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.
        Stroke. 2018; 49 (2018): e46-e110
        • Almekhlafi MA
        • Goyal M
        • Dippel DWJ
        • et al.
        Healthy life-year costs of treatment speed from arrival to endovascular thrombectomy in patients with ischemic stroke: A meta-analysis of individual patient data from 7 randomized clinical trials.
        JAMA Neurol. 2021; 78: 709-717
        • Mair G
        • Boyd EV
        • Chappell FM
        • et al.
        Sensitivity and specificity of the hyperdense artery sign for arterial obstruction in acute ischemic stroke.
        Stroke. 2015; 46: 102-107
        • Lombardi S
        • Riva L
        • Patassini M
        • et al.
        “Hyperdense artery sign” in early ischemic stroke: diagnostic value of model-based reconstruction approach in comparison with standard hybrid iterative reconstruction algorithm.
        Neuroradiology. 2018; 60: 1273-1280
        • Rosskopf J
        • Kloth C
        • Dreyhaupt J
        • et al.
        Thin slices and maximum intensity projection reconstructions increase sensitivity to hyperdense middle cerebral artery sign in acute ischemic stroke.
        Cerebrovasc Dis. 2020; 49: 437-441
        • Kobayashi Y
        • Morizumi T
        • Okumura G
        • et al.
        Visualization of thrombus using iterative reconstruction and maximum intensity projection of thin-slice CT images.
        Neuroradiology. 2022; 16: 1-7
        • van Swieten JC
        • Koudstaal PJ
        • Visser MC
        • et al.
        Interobserver agreement for the assessment of handicap in stroke patients.
        Stroke. 1988; 19: 604-607
        • Lyden P
        • Brott T
        • Tilley B
        • et al.
        Improved reliability of the NIH Stroke Scale using video training. NINDS TPA Stroke Study Group.
        Stroke. 1994; 25: 2220-2226
        • Barber PA
        • Demchuk AM
        • Zhang J
        • et al.
        Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS study group. Alberta stroke programme early CT score.
        Lancet. 2000; 355: 1670-1674
      1. Itabashi R, Shigehatake Y, Saito T, et al. Rapid evaluation of large vessel occlusion for mechanical thrombectomy using carotid duplex ultrasound, Internal Medicine 2022 in press.

        • Adams Jr, HP
        • Bendixen BH
        • Kappelle LJ
        • et al.
        Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment.
        Stroke. 1993; 24: 35-41
        • Zaidat OO
        • Yoo AJ
        • Khatri P
        • et al.
        Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement.
        Stroke. 2013; 44: 2650-2663
        • Gács G
        • Fox AJ
        • Barnett HJ
        • et al.
        CT visualization of intracranial arterial thromboembolism.
        Stroke. 1983; 14: 756-762
        • Willemink MJ
        • de Jong PA
        • Leiner T
        • et al.
        Iterative reconstruction techniques for computed tomography Part 1: technical principles.
        Eur Radiol. 2013; 23: 1623-1631
        • Wintermark M
        • Luby M
        • Bornstein NM
        • et al.
        International survey of acute stroke imaging used to make revascularization treatment decisions.
        Int J Stroke. 2015; 10: 759-762
        • Demchuk AM
        • Menon BK
        • Goyal M.
        Comparing vessel imaging: noncontrast computed tomography/computed tomographic angiography should be the new minimum standard in acute disabling stroke.
        Stroke. 2016; 47: 273-281
        • Weiss D
        • Kraus B
        • Rubbert C
        • et al.
        Systematic evaluation of computed tomography angiography collateral scores for estimation of long-term outcome after mechanical thrombectomy in acute ischaemic stroke.
        Neuroradiol J. 2019; 32: 277-286
        • van der Molen AJ
        • Reimer P
        • Dekkers IA
        • et al.
        Post-contrast acute kidney injury - Part 1: definition, clinical features, incidence, role of contrast medium, and risk factors: recommendations for updated ESUR contrast medium safety committee guidelines.
        Eur Radiol. 2018; 28: 2845-2855
        • Bouslama M
        • Haussen DC
        • Grossberg JA
        • et al.
        Computed tomographic perfusion selection and clinical outcomes after endovascular therapy in large vessel occlusion stroke.
        Stroke. 2017; 48: 1271-1277
        • Jadhav AP
        • Goyal M
        • Ospel J
        • et al.
        Thrombectomy with and without computed tomography perfusion imaging in the early time window: a pooled analysis of patient-level data.
        Stroke. 2022; 53: 1348-1353
        • Mendez B
        • Requena M
        • Aires A
        • et al.
        Direct transfer to angio-suite to reduce workflow times and increase favorable clinical outcome.
        Stroke. 2018; 49: 2723-2727