DSA-based perfusion parameters versus TICI score after mechanical thrombectomy in acute ischaemic stroke patients: a congruence analysis
Abstract Background Several factors are frequently considered for outcome prediction rin stroke patients. We assessed the value of digital subtraction angiography (DSA)-based brain perfusion measurements after mechanical thrombectomy (MT) for outcome prediction in acute ischaemic stroke. Methods Fro...
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2024-12-01
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| Series: | European Radiology Experimental |
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| Online Access: | https://doi.org/10.1186/s41747-024-00534-1 |
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| author | Sebastian R. Reder Andrea Kronfeld Sonja Gröschel Arda Civelek Klaus Gröschel Marc A. Brockmann Timo Uphaus Marianne Hahn Carolin Brockmann Ahmed E. Othman |
| author_facet | Sebastian R. Reder Andrea Kronfeld Sonja Gröschel Arda Civelek Klaus Gröschel Marc A. Brockmann Timo Uphaus Marianne Hahn Carolin Brockmann Ahmed E. Othman |
| author_sort | Sebastian R. Reder |
| collection | DOAJ |
| description | Abstract Background Several factors are frequently considered for outcome prediction rin stroke patients. We assessed the value of digital subtraction angiography (DSA)-based brain perfusion measurements after mechanical thrombectomy (MT) for outcome prediction in acute ischaemic stroke. Methods From DSA image data (n = 90; 38 females; age 73.3 ± 13.1 years [mean ± standard deviation]), time-contrast agent (CA) concentration curves were acquired, and maximum slope (MS), time to peak (TTP), and maximum CA concentration (CAmax) were calculated using an arterial input function. This data was used to predict neurological deficits at 24 h and upon discharge by using multiple regression analysis; the predictive capability was compared with the predictive power of the “Thrombolysis in cerebral infarction” (TICI) score. Intraclass correlation coefficients (ICC) of the NIHSS values were analysed. Results The comparison of means revealed a linear trend after stratification into TICI classes for CAmax (TICI 0: 0.07 ± 0.02 a.u. to TICI 3: 0.22 ± 0.07 a.u.; p < 0.001), and for MS (TICI 0: 0.04 ± 0.01 a.u./s to TICI 3: 0.12 ± 0.0 a.u./s; p < 0.001). Regression analyses demonstrated equivalent capabilities for estimating neurological deficits after 24 h and at discharge using both the TICI score and DSA-based perfusion parameters (ΔR² ~ 0.03). Compared to the actual NIHSS, the ICC ranged from 0.55 to 0.84 for DSA-based models and from 0.6 to 0.82 for TICI-based models. Conclusion Semi-quantitative evaluation of DSA-based perfusion parameters prior to and after MT is feasible and could enhance the objectivity and comparability of MT outcome prediction. This technique may offer novel approaches in acute ischaemic stroke management and data comparability. Relevance statement DSA-based brain perfusion measurements following interventional stroke therapy could allow for an experience-independent assessment of reperfusion success. It demonstrates predictive power at least equivalent to the established methods. This could support a future automated DSA-based brain perfusion measurement method. Key Points Currently, the evaluation of stroke therapy success is based on the treating physician’s experience. The present study introduces an objective semi-quantitative evaluation method. In predicting clinical outcomes, the traditional expert-based and semi-quantitative methods are equivalent. Graphical Abstract |
| format | Article |
| id | doaj-art-02de84ee91c74765a0d77aa5e88d76d9 |
| institution | OA Journals |
| issn | 2509-9280 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | SpringerOpen |
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| spelling | doaj-art-02de84ee91c74765a0d77aa5e88d76d92025-08-20T02:31:00ZengSpringerOpenEuropean Radiology Experimental2509-92802024-12-018111910.1186/s41747-024-00534-1DSA-based perfusion parameters versus TICI score after mechanical thrombectomy in acute ischaemic stroke patients: a congruence analysisSebastian R. Reder0Andrea Kronfeld1Sonja Gröschel2Arda Civelek3Klaus Gröschel4Marc A. Brockmann5Timo Uphaus6Marianne Hahn7Carolin Brockmann8Ahmed E. Othman9Department of Neuroradiology, University Medical Center, Johannes Gutenberg-University of MainzDepartment of Neuroradiology, University Medical Center, Johannes Gutenberg-University of MainzDepartment of Neurology, University Medical Center of the Johannes Gutenberg-University of MainzDepartment of Neurology, University Medical Center of the Johannes Gutenberg-University of MainzDepartment of Neurology, University Medical Center of the Johannes Gutenberg-University of MainzDepartment of Neuroradiology, University Medical Center, Johannes Gutenberg-University of MainzDepartment of Neurology, University Medical Center of the Johannes Gutenberg-University of MainzDepartment of Neurology, University Medical Center of the Johannes Gutenberg-University of MainzDepartment of Neuroradiology, University Medical Center, Johannes Gutenberg-University of MainzDepartment of Neuroradiology, University Medical Center, Johannes Gutenberg-University of MainzAbstract Background Several factors are frequently considered for outcome prediction rin stroke patients. We assessed the value of digital subtraction angiography (DSA)-based brain perfusion measurements after mechanical thrombectomy (MT) for outcome prediction in acute ischaemic stroke. Methods From DSA image data (n = 90; 38 females; age 73.3 ± 13.1 years [mean ± standard deviation]), time-contrast agent (CA) concentration curves were acquired, and maximum slope (MS), time to peak (TTP), and maximum CA concentration (CAmax) were calculated using an arterial input function. This data was used to predict neurological deficits at 24 h and upon discharge by using multiple regression analysis; the predictive capability was compared with the predictive power of the “Thrombolysis in cerebral infarction” (TICI) score. Intraclass correlation coefficients (ICC) of the NIHSS values were analysed. Results The comparison of means revealed a linear trend after stratification into TICI classes for CAmax (TICI 0: 0.07 ± 0.02 a.u. to TICI 3: 0.22 ± 0.07 a.u.; p < 0.001), and for MS (TICI 0: 0.04 ± 0.01 a.u./s to TICI 3: 0.12 ± 0.0 a.u./s; p < 0.001). Regression analyses demonstrated equivalent capabilities for estimating neurological deficits after 24 h and at discharge using both the TICI score and DSA-based perfusion parameters (ΔR² ~ 0.03). Compared to the actual NIHSS, the ICC ranged from 0.55 to 0.84 for DSA-based models and from 0.6 to 0.82 for TICI-based models. Conclusion Semi-quantitative evaluation of DSA-based perfusion parameters prior to and after MT is feasible and could enhance the objectivity and comparability of MT outcome prediction. This technique may offer novel approaches in acute ischaemic stroke management and data comparability. Relevance statement DSA-based brain perfusion measurements following interventional stroke therapy could allow for an experience-independent assessment of reperfusion success. It demonstrates predictive power at least equivalent to the established methods. This could support a future automated DSA-based brain perfusion measurement method. Key Points Currently, the evaluation of stroke therapy success is based on the treating physician’s experience. The present study introduces an objective semi-quantitative evaluation method. In predicting clinical outcomes, the traditional expert-based and semi-quantitative methods are equivalent. Graphical Abstracthttps://doi.org/10.1186/s41747-024-00534-1Angiography (digital subtraction)Ischemic strokeOutcomePerfusion imagingThrombectomy |
| spellingShingle | Sebastian R. Reder Andrea Kronfeld Sonja Gröschel Arda Civelek Klaus Gröschel Marc A. Brockmann Timo Uphaus Marianne Hahn Carolin Brockmann Ahmed E. Othman DSA-based perfusion parameters versus TICI score after mechanical thrombectomy in acute ischaemic stroke patients: a congruence analysis European Radiology Experimental Angiography (digital subtraction) Ischemic stroke Outcome Perfusion imaging Thrombectomy |
| title | DSA-based perfusion parameters versus TICI score after mechanical thrombectomy in acute ischaemic stroke patients: a congruence analysis |
| title_full | DSA-based perfusion parameters versus TICI score after mechanical thrombectomy in acute ischaemic stroke patients: a congruence analysis |
| title_fullStr | DSA-based perfusion parameters versus TICI score after mechanical thrombectomy in acute ischaemic stroke patients: a congruence analysis |
| title_full_unstemmed | DSA-based perfusion parameters versus TICI score after mechanical thrombectomy in acute ischaemic stroke patients: a congruence analysis |
| title_short | DSA-based perfusion parameters versus TICI score after mechanical thrombectomy in acute ischaemic stroke patients: a congruence analysis |
| title_sort | dsa based perfusion parameters versus tici score after mechanical thrombectomy in acute ischaemic stroke patients a congruence analysis |
| topic | Angiography (digital subtraction) Ischemic stroke Outcome Perfusion imaging Thrombectomy |
| url | https://doi.org/10.1186/s41747-024-00534-1 |
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