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Predictive Value of Computed Tomography Angiography-Determined Occlusion Type in Stent Retriever Thrombectomy

 Jang-Hyun Baek  ;  Byung Moon Kim  ;  Joonsang Yoo  ;  Hyo Suk Nam  ;  Young Dae Kim  ;  Dong Joon Kim  ;  Ji Hoe Heo  ;  Oh Young Bang 
 Stroke, Vol.48(10) : 2746-2752, 2017 
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Issue Date
Aged ; Aged, 80 and over ; Computed Tomography Angiography/methods* ; Endovascular Procedures/methods ; Female ; Humans ; Male ; Middle Aged ; Multidetector Computed Tomography/methods ; Predictive Value of Tests ; Retrospective Studies ; Stents* ; Stroke/diagnostic imaging* ; Stroke/surgery* ; Thrombectomy/methods*
angiography, digital subtraction ; computed tomography angiography ; intracranial atherosclerosis ; stroke ; thrombectomy
BACKGROUND AND PURPOSE: We investigated whether occlusion type identified with computed tomography angiography (CTA-determined occlusion type) could predict endovascular treatment success using stent retriever (SR) thrombectomy. METHODS: Consecutive patients with stroke who underwent CTA and then endovascular treatment for intracranial large artery occlusion were retrospectively reviewed. CTA-determined occlusion type was classified into truncal-type occlusion or branching-site occlusion and compared with digital subtraction angiography-determined occlusion type during endovascular treatment. Three rapidly- and readily-assessable pre-procedural findings (CTA-determined occlusion type, atrial fibrillation, and hyperdense artery sign), which may infer occlusion pathomechanism (embolic versus nonembolic) before endovascular treatment, were evaluated for association with SR success along with stroke risk factors and laboratory results. In addition, the predictive power of the 3 pre-procedural findings for SR success was compared with receiver operating characteristic curve analyses. RESULTS: A total of 238 patients (mean age, 70.0 years; male patients, 52.9%) were included in this study. CTA-determined occlusion type corresponded adequately with digital subtraction angiography-determined occlusion type (P=0.453). Atrial fibrillation (odds ratio, 2.66; 95% confidence interval, 1.25-5.66) and CTA-determined branching-site occlusion (odds ratio, 8.20; confidence interval, 3.45-19.5) were independent predictors for SR success. For predicting SR success, the area under the receiver operating characteristic curve value for CTA-determined branching-site occlusion (0.695) was significantly greater than atrial fibrillation (0.594; P=0.038) and hyperdense artery sign (0.603; P=0.023). CONCLUSIONS: CTA-determined branching-site occlusion was significantly associated with SR success. Furthermore, among the 3 rapidly- and readily-assessable pre-procedural findings, CTA-determined branching-site occlusion had the greatest predictive power for SR success.
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실)
Yonsei Authors
김동준(Kim, Dong Joon) ; 김병문(Kim, Byung Moon) ; 김영대(Kim, Young Dae) ; 남효석(Nam, Hyo Suk) ; 허지회(Heo, Ji Hoe)
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