J Stroke.  2024 Jan;26(1):108-111. 10.5853/jos.2023.02768.

Perfusion Profiles May Differ Between Asymptomatic Versus Symptomatic Internal Carotid Artery Occlusion

• Chang TY
• Christensen S
• Mlynash M
• Heit JJ
• Marks MP
• Lee S
• McCullough-Hicks ME
• Ostojic LV
• Kemp S
• Albers GW
• Srivatsan A
• Lee TH
• Lansberg MG

• KMID: 2551353
• DOI: http://doi.org/10.5853/jos.2023.02768

Figure

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  Figure 1. Quantitative perfusion measurements. (A) Box plots showing the comparisons of Tmax (>4 s, >6 s, >8 s, and >10 s) volumes between patients with asymptomatic (blue) and symptomatic (red) internal carotid artery occlusions (ICAO). Patients with symptomatic occlusions had larger Tmax lesion volumes for each Tmax threshold (*P<0.01). (B) Receiver operating characteristic (ROC) curves for the four Tmax thresholds and for the hypoperfusion intensity ratio (HIR, orange) to distinguish symptomatic from asymptomatic ICAO. The largest area-under-curve (AUC) was observed for the curves of Tmax10 (blue; AUC=0.99, 95% confidence interval (CI)=0.96–1.00) and Tmax8 (green; AUC=0.98, 95% CI=0.97–1.00).

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  Figure 2. Decision algorithm for classification. (A) Decision tree to differentiate symptomatic from asymptomatic internal carotid occlusion (ICAO) based on magnetic resonance perfusion characteristics. (B) Raters’ ability to differentiate asymptomatic and symptomatic patients according to the decision tree. MTT, mean transit time; CBF, cerebral blood flow.

Reference

References

1. Sarraj A, Albers GW, Blasco J, Arenillas JF, Ribo M, Hassan AE, et al. Thrombectomy versus medical management in mild strokes due to large vessel occlusion: exploratory analysis from the EXTEND-IA trials and a pooled international cohort. Ann Neurol. 2022; 92:364–378.

2. Lansberg MG, Straka M, Kemp S, Mlynash M, Wechsler LR, Jovin TG, et al. MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort study. Lancet Neurol. 2012; 11:860–867.

3. Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, OrtegaGutierrez S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018; 378:708–718.

4. Guenego A, Marcellus DG, Martin BW, Christensen S, Albers GW, Lansberg MG, et al. Hypoperfusion intensity ratio is correlated with patient eligibility for thrombectomy. Stroke. 2019; 50:917–922.

5. Zhang B, Wang G, Gao Y, Tan H, Wang P. Influence of the integrity of circle of Willis on asymptomatic or mild patients with first diagnosed chronic internal carotid artery occlusion. Eur J Radiol. 2023; 165:110954.

6. Lee MJ, Son JP, Kim SJ, Ryoo S, Woo SY, Cha J, et al. Predicting collateral status with magnetic resonance perfusion parameters: probabilistic approach with a Tmax-derived prediction model. Stroke. 2015; 46:2800–2807.

7. Ishikawa M, Sugawara H, Nagai M, Kusaka G, Tanaka Y, Naritaka H. Collateral flow and white matter disease in patients with internal carotid artery occlusion. Eur Neurol. 2017; 77:56–65.

8. Chaves CJ, Staroselskaya I, Linfante I, Llinas R, Caplan LR, Warach S. Patterns of perfusion-weighted imaging in patients with carotid artery occlusive disease. Arch Neurol. 2003; 60:237–242.

9. Calamante F, Christensen S, Desmond PM, Ostergaard L, Davis SM, Connelly A. The physiological significance of the time-to-maximum (Tmax) parameter in perfusion MRI. Stroke. 2010; 41:1169–1174.

10. Thanvi B, Robinson T. Complete occlusion of extracranial internal carotid artery: clinical features, pathophysiology, diagnosis and management. Postgrad Med J. 2007; 83:95–99.