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  • Wiley  (4)
  • Karamchandani, Rahul R.  (4)
  • 1
    Online Resource
    Online Resource
    The Charlotte large artery occlusion endovascular therapy outcome score predicts outcome after basilar artery thrombectomy
    Wiley ; 2022
    In:  Journal of Neuroimaging Vol. 32, No. 5 ( 2022-09), p. 860-865
    Details
    In: Journal of Neuroimaging, Wiley, Vol. 32, No. 5 ( 2022-09), p. 860-865
    Abstract: The Charlotte Large artery occlusion Endovascular therapy Outcome Score (CLEOS) and Totaled Health Risks in Vascular Events (THRIVE) predict functional outcomes after anterior circulation endovascular thrombectomy (EVT). We evaluated the performance of CLEOS and THRIVE in patients presenting with an acute basilar artery occlusion (BAO) treated with EVT. Methods We conducted a retrospective analysis of a health system's stroke registry. Patients presenting with an acute BAO treated with EVT and evaluated with pre‐thrombectomy CT perfusion (CTP) from January 2017 to December 2021 were included. CLEOS = (5 × age) + (10 × National Institutes of Health Stroke Scale [NIHSS]) + Glucose – (150 × CTP cerebral blood volume index) and THRIVE (0‐9 points) = age 60‐79 years, 1 point; age ≥ 80 years, 2 points; NIHSS 11‐20, 2 points; NIHSS ≥ 21, 4 points; hypertension, diabetes mellitus, atrial fibrillation, 1 point each. Multivariable logistic regression was performed for the ability of CLEOS and THRIVE to predict the primary outcome, modified Rankin Scale score 3‐6. Results Fifty‐seven patients had mean age 66.6 (± 14.9) years and median NIHSS 15.5 (5‐24). In the multivariable regression analysis, increased CLEOS was associated with significantly higher odds of a poor functional outcome (odds ratio [OR] = 1.0011, 95% confidence interval [CI] : 1.0003‐1.0019, p  = .008), whereas THRIVE was not (OR = 1.0326, 95% CI: 0.9478‐1.1250, p  = .466). CLEOS  〉  503 best predicted poor outcomes. Conclusions A higher CLEOS score was associated with elevated odds of a poor 90‐day functional outcome in our cohort of acute BAO patients treated with EVT.
    Type of Medium: Online Resource
    ISSN: 1051-2284 , 1552-6569
    URL: Issue
    URL: Article
    DOI: 10.1111/jon.v32.5
    DOI: 10.1111/jon.13039
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2035400-9
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  • 2
    Online Resource
    Online Resource
    Automated detection of intracranial large vessel occlusions using Viz.ai software: Experience in a large, integrated stroke network
    Wiley ; 2023
    In:  Brain and Behavior Vol. 13, No. 1 ( 2023-01)
    Details
    In: Brain and Behavior, Wiley, Vol. 13, No. 1 ( 2023-01)
    Abstract: Endovascular thrombectomy is an evidence‐based treatment for large vessel occlusion (LVO) stroke. Commercially available artificial intelligence has been designed to detect the presence of an LVO on computed tomography angiogram (CTA). We compared Viz.ai‐LVO (San Francisco, CA, USA) to CTA interpretation by board‐certified neuroradiologists (NRs) in a large, integrated stroke network. Methods From January 2021 to December 2021, we compared Viz.ai detection of an internal carotid artery (ICA) or middle cerebral artery first segment (MCA‐M1) occlusion to the gold standard of CTA interpretation by board‐certified NRs for all code stroke CTAs. On a monthly basis, sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Trend analyses were conducted to evaluate for any improvement of LVO detection by the software over time. Results 3851 patients met study inclusion criteria, of whom 220 (5.7%) had an ICA or MCA‐M1 occlusion per NR. Sensitivity and specificity were 78.2% (95% CI 72%–83%) and 97% (95% CI 96%–98%), respectively. PPV was 61% (95% CI 55%–67%), NPV 99% (95% CI 98%–99%), and accuracy was 95.9% (95% CI 95.3%–96.5%). Neither specificity or sensitivity improved over time in the trend analysis. Conclusions Viz.ai‐LVO has high specificity and moderately high sensitivity to detect an ICA or proximal MCA occlusion. The software has the potential to streamline code stroke workflows and may be particularly impactful when emergency access to NRs or vascular neurologists is limited.
    Type of Medium: Online Resource
    ISSN: 2162-3279 , 2162-3279
    URL: Issue
    URL: Article
    DOI: 10.1002/brb3.v13.1
    DOI: 10.1002/brb3.2808
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2623587-0
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  • 3
    Online Resource
    Online Resource
    The Charlotte Large artery occlusion Endovascular therapy Outcome Score predicts independent outcome after thrombectomy
    Wiley ; 2023
    In:  Journal of Neuroimaging
    Details
    In: Journal of Neuroimaging, Wiley
    Abstract: Predicting functional outcomes after endovascular thrombectomy (EVT) is of interest to patients and families as they navigate hospital and post‐acute care decision‐making. We evaluated the prognostic ability of several scales to predict good neurological function after EVT. Methods We retrospectively analyzed records from a health system's code stroke registry, including consecutive successful thrombectomy patients from August 2020 to February 2023 presenting with an anterior circulation large vessel occlusion who were evaluated with pre‐EVT CT perfusion. Primary and secondary outcomes were 90‐day modified Rankin Scale (mRS) scores 0‐2 and 0‐1, respectively. Logistic regression was performed to evaluate the ability of each scale to predict the outcomes. Scales were compared by calculating the area under the curve (AUC). Results A total of 465 patients (mean age 68.1 [±14.9] years, median National Institutes of Health Stroke Scale [NIHSS] 16 [11‐21]) met inclusion criteria. In the logistic regression, the Charlotte Large artery occlusion Endovascular therapy Outcome Score (CLEOS), Totaled Health Risks in Vascular Events, Houston Intra‐Arterial Therapy‐2, Pittsburgh Response to Endovascular therapy, and Stroke Prognostication using Age and NIHSS were significant in predicting the primary and secondary outcomes. CLEOS was superior to all other scales in predicting 90‐day mRS 0‐2 (AUC .75, 95% confidence interval [CI] .70‐.80) and mRS 0‐1 (AUC .74, 95% CI .69‐.78). Twenty of 22 patients (90.9%) with CLEOS 〈 315 had 90‐day mRS 0‐2. Conclusions CLEOS predicts independent and excellent neurological function after anterior circulation EVT.
    Type of Medium: Online Resource
    ISSN: 1051-2284 , 1552-6569
    URL: Article
    DOI: 10.1111/jon.13151
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2035400-9
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  • 4
    Online Resource
    Online Resource
    Cerebral blood volume index as a predictor of functional independence after basilar artery thrombectomy
    Wiley ; 2022
    In:  Journal of Neuroimaging Vol. 32, No. 1 ( 2022-01), p. 171-178
    Details
    In: Journal of Neuroimaging, Wiley, Vol. 32, No. 1 ( 2022-01), p. 171-178
    Abstract: The role of CT perfusion (CTP)in the evaluation of acute basilar artery occlusion (aBAO) patients undergoing endovascular thrombectomy (EVT) is unclear. We investigated the association of individual CTP parameters with functional outcomes in aBAO patients undergoing EVT. Methods A health system's prospectively collected code stroke registry was used in this retrospective analysis of aBAO patients treated with EVT presenting between January 2017 and February 2021 with pre‐EVT CTP. The primary outcome measure was modified Rankin Scale (mRS) score 0‐2 at 90 days. Factors with a univariate association ( p 〈 .05) with mRS 0‐2 were combined in a multivariable regression model to determine independent predictors of 90‐day favorable functional outcome. Results Forty‐six subjects, with median age 67 years and median National Institutes of Health Stroke Scale 16, were included, of whom 17 (37%) achieved mRS 0‐2 at 90 days. In the multivariable logistic regression model, CTP cerebral blood volume (CBV) index (per 0.1‐point increase, odds ratio = 1.843; 95% confidence interval: 1.039, 3.268; p ‐value .0365) was independently associated with a favorable 90‐day outcome. Conclusions CBV index was independently associated with a favorable 90‐day outcome in aBAO patients treated with EVT, a novel finding in this patient population. CBV index may assist in treatment and prognosis discussions and inform future studies investigating the role of CTP in aBAO.
    Type of Medium: Online Resource
    ISSN: 1051-2284 , 1552-6569
    URL: Issue
    URL: Article
    DOI: 10.1111/jon.v32.1
    DOI: 10.1111/jon.12933
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2035400-9
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