Duvekot Martijne H C, van Es Adriaan C G M, Venema Esmee, Wolff Lennard, Rozeman Anouk D, Moudrous Walid, Vermeij Frédérique H, Lingsma Hester F, Bakker Jeannette, Plaisier Aarnout S, Hensen Jan-Hein J, Lycklama À Nijeholt Geert J, Jan van Doormaal Pieter, Dippel Diederik W J, Kerkhoff Henk, Roozenbeek Bob, van der Lugt Aad
Department of Neurology, Albert Schweitzer hospital, Dordrecht, the Netherlands.
Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Eur Stroke J. 2021 Dec;6(4):357-366. doi: 10.1177/23969873211058576. Epub 2021 Nov 12.
Early detection of large vessel occlusion (LVO) is essential to facilitate fast endovascular treatment. CT angiography (CTA) is used to detect LVO in suspected stroke patients. We aimed to assess the accuracy of CTA evaluations in daily clinical practice in a large cohort of suspected stroke patients.
We used data from the PRESTO study, a multicenter prospective observational cohort study that included suspected stroke patients between August 2018 and September 2019. Baseline CTAs were re-evaluated by an imaging core laboratory and compared to the local assessment. LVO was defined as an occlusion of the intracranial internal carotid artery, M1 segment, or basilar artery. Medium vessel occlusion (MeVO) was defined as an A1, A2, or M2 occlusion. We calculated the accuracy, sensitivity, and specificity to detect LVO and LVO+MeVO, using the core laboratory evaluation as reference standard.
We included 656 patients. The core laboratory detected 89 LVOs and 74 MeVOs in 155 patients. Local observers missed 6 LVOs (7%) and 28 MeVOs (38%), of which 23 M2 occlusions. Accuracy of LVO detection was 99% (95% CI: 98-100%), sensitivity 93% (95% CI: 86-97%), and specificity 100% (95% CI: 99-100%). Accuracy of LVO+MeVO detection was 95% (95% CI: 93-96%), sensitivity 79% (95% CI: 72-85%), and specificity 99% (95% CI: 98-100%).
CTA evaluations in daily clinical practice are highly accurate and LVOs are adequately recognized. The detection of MeVOs seems more challenging. The evolving EVT possibilities emphasize the need to improve CTA evaluations in the acute setting.
早期发现大血管闭塞（LVO）对于促进快速血管内治疗至关重要。CT血管造影（CTA）用于检测疑似中风患者的LVO。我们旨在评估在一大群疑似中风患者的日常临床实践中CTA评估的准确性。
我们使用了PRESTO研究的数据，这是一项多中心前瞻性观察队列研究，纳入了2018年8月至2019年9月期间的疑似中风患者。基线CTA由影像核心实验室重新评估，并与当地评估结果进行比较。LVO定义为颅内颈内动脉、M1段或基底动脉闭塞。中血管闭塞（MeVO）定义为A1、A2或M2段闭塞。我们以核心实验室评估为参考标准，计算检测LVO和LVO+MeVO的准确性、敏感性和特异性。
我们纳入了656例患者。核心实验室在155例患者中检测到89例LVO和74例MeVO。当地观察者漏诊了6例LVO（7%）和28例MeVO（38%），其中23例为M2段闭塞。LVO检测的准确性为99%（95%CI：98-100%），敏感性为93%（95%CI：86-97%），特异性为100%（95%CI：99-100%）。LVO+MeVO检测的准确性为95%（95%CI：93-96%），敏感性为79%（95%CI：72-85%），特异性为99%（95%CI：98-100%）。
日常临床实践中的CTA评估高度准确，LVO能够得到充分识别。MeVO的检测似乎更具挑战性。不断发展的血管内治疗可能性强调了在急性情况下改进CTA评估的必要性。
