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Abstract Details

Timing invariant CTA derived from CTP preserves high diagnostic yield for MCA-M2 occlusions
Cerebrovascular Disease and Interventional Neurology
S57 - Acute Treatment and Imaging of Ischemic Stroke (1:22 PM-1:33 PM)
003

A timing invariant CT angiography (CTA) derived from CT perfusion (CTP) data avoids additional contrast, radiation exposure and time associated with traditional CTA. Previous studies have validated this technique for LVO confined to M1 MCA. With advances in endovascular techniques, the previously considered “distal” branches of MCA like M2 segments are now considered amenable to thrombectomy.

To test reliability of time invariant CTA derived from CTP for identifying M2 MCA occlusions. 

We retrospectively review consecutive patients with CTP. CT perfusion protocol used 40 cc of iodinated contrast and 40 seconds acquisition time. Timing invariant CTA images were generated from the CT perfusion data. Volume perfusion CT data were routinely reconstructed with a slice width of 1.5 mm every 1 mm for CTA analysis .We scored  those scans for subjective CTA image quality of the M1/M2 segments, presence, absence and site of occlusion recorded by three blinded independent reviewers and compared to diagnostic cerebral angiogram (DSA) read by an independent neurointerventionalist in cases 24/45 cases that underwent endovascular intervention. Observed probability of agreement was computed to measure agreement. 

Out of 45 patients analyzed 1 had no occlusion,20 had M1 and 24 had M2 occlusion. The image quality observed agreement ranged from 96% (95% CI: 92-99%) for M1 occlusion to 77% (95% CI:  72-81%) for distal M2 occlusion. The observed agreements compared 3 image reviewers vs DSA in M2 patients (n=24) was 98% for identifying occlusion (95% CI 95-100%), 94% for identifying proximal M2 occlusion (95% CI 88-98%). Beyond the bifurcation there was 91% (95% CI 84-97%) and 90% ( 95% CI 83-95%) agreement respectively for correctly identifying inferior and superior branch of M2 occlusion. 

Time invariant CTA derived from CTP data preserves high diagnostic yield for correctly identifying M2 MCA occlusion without addition of dedicated CTA

Authors/Disclosures
Kaustubh S. Limaye, MD (Indiana University School of Medicine)
PRESENTER
Dr. Limaye has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Scientia Vascular.
No disclosure on file
No disclosure on file
No disclosure on file
Sami Alkasab, MD (University of Iowa) No disclosure on file
Sudeepta Dandapat, MD (Aurora Neurosciences Innovation Institute) Dr. Dandapat has nothing to disclose.
Waldo Guerrero, MD (University of South Florida College of Medicine) Dr. Guerrero has nothing to disclose.
No disclosure on file
Edgar Samaniego, MD, FAAN (University of Iowa Hospital and Clinics) Dr. Samaniego has received personal compensation for serving as an employee of University of Iowa. Dr. Samaniego has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Microvention. Dr. Samaniego has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Rapid Medical. Dr. Samaniego has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Cerenovus. Dr. Samaniego has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Metronic. Dr. Samaniego has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Society of Neurointerventional Surgery. Dr. Samaniego has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Neurointerventional Surgery.
David Hasan No disclosure on file
Enrique C. Leira, MD, MS, FAAN (University of Iowa Department of Neurology, Comprehensive Stroke Center) Dr. Leira has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AHA. The institution of Dr. Leira has received research support from NIH-NINDS.
Colin Derdeyn, MD (University of Iowa Hospitals & Clinics) The institution of Dr. Derdeyn has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Penumbra. The institution of Dr. Derdeyn has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NoNO. The institution of Dr. Derdeyn has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Silk Road. Dr. Derdeyn has stock in Pulse Therapeutics. Dr. Derdeyn has received publishing royalties from a publication relating to health care.
No disclosure on file