Comparison of multimodal CT scan protocols used for decision-making on mechanical thrombectomy in acute ischemic stroke.

Rujimas Khumtong, Timo Krings, Vitor M Pereira, Aleksandra Pikula, Joanna D Schaafsma

Abstract readComparative Study

In one paragraph

Article in Neuroradiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it

0cells of the map it votes in

4citing papers in PubMed

1.7field-weighted citation impact, top 15% of its field

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 14 citations in OpenAlex.

Clinical Uncertainty in Large Vessel Occlusion ischemic stroke (CULVO): Does automated perfusion scanning make a difference? Protocol of an intrarater and interrater agreement study.PloS one · 2024
Article
Accuracy of Computed Tomography Angiography for Diagnosing Extracranial Mural Lesions in Patients with Acute Internal Carotid Artery Occlusion: Correlation with Digital Subtraction Angiography.Journal of personalized medicine · 2023
Article
Variability of acquisition phase of computed tomography angiography in acute ischemic stroke in a real-world scenario.European radiology · 2022
Article
Early Diagnosis of Acute Ischemic Stroke by Brain Computed Tomography Perfusion Imaging Combined with Head and Neck Computed Tomography Angiography on Deep Learning Algorithm.Contrast media & molecular imaging · 2022
Article

4 · The record

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5 · Who and what money

Authors and funding

5 authors at 1 institution in 2 countries.

Rujimas KhumtongDivision of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada.

Timo KringsDivision of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada.

Vitor M PereiraDivision of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada.

Aleksandra PikulaDivision of Neurology, Department of Medicine, Toronto Western Hospital, University Health Network, University of Toronto, 5WW-425, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.

Joanna D SchaafsmaDivision of Neurology, Department of Medicine, Toronto Western Hospital, University Health Network, University of Toronto, 5WW-425, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada. joanna.schaafsma@uhn.ca.ORCID http://orcid.org/0000-0003-4326-5597

University Health Network · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeDifferent CT-based protocols are being used in acute ischemic stroke. We aimed to assess the added value of delayed-phase CT angiography (CTA) and CT perfusion (CTP) to a basic protocol using non-contrast computerized tomography (NCCT) with arterial-phase CTA in patient selection for mechanical thrombectomy.

methodsWe retrospectively included consecutive acute ischemic stroke patients with a symptomatic intracranial arterial occlusion between January 2015 and November 2016 who underwent NCCT, arterial and delayed-phase CTA, and CTP. These imaging studies were grouped into five protocols: (1) NCCT and arterial-phase CTA; (2) NCCT, arterial-phase CTA, and CTP; (3) NCCT, arterial- and delayed-phase CTA; (4) NCCT, arterial- and delayed-phase CTA, and CTP; and (5) NCCT and delayed-phase CTA. Two interventional neuro-radiologists independently decided on mechanical thrombectomy for each patient based on the protocols. They reached consensus for discrepant decisions. We assessed the raters' confidence level, inter-rater agreement, and compared treatment decisions for the different protocols.

resultsWe included 73 patients (44% male, mean age 74). The inter-rater agreement was substantial for protocols with three or more modalities (ҡ = 0.613-0.704) and moderate for two-modality protocols (ҡ = 0.506-0.529). The highest agreement and confidence level was achieved for the combination of NCCT, arterial-phase CTA, and CTP. Adding CTP to NCCT and arterial-phase CTA resulted in a 10% increase of recommendations for mechanical thrombectomy and adding delayed-phase CTA resulted in a 4% increase. These management changes did not reach statistical significance (p = 0.07; p = 0.25, respectively).

conclusionAdding CTP and/or a delayed-phase CTA to NCCT with arterial-phase CTA improves the decision-maker's confidence level and creates a trend towards a lower threshold for mechanical thrombectomy.

Indexed as

ThrombectomyAgedCerebral AngiographyComputed Tomography AngiographyContrast MediaFemaleHumansIohexolIschemic StrokeMalePatient SelectionRetrospective StudiesContrast MediaIohexoliopromideComputed tomography angiographyCT perfusionDecision-makingStrokeThrombectomy

Identifiers

PMID31901973

DOI10.1007/s00234-019-02351-5

OpenAlexW2998594719

What OpenQuestion holds

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Read underepoch 390

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.