Novel vascular territory mapping algorithm as a predictive tool for identification of antegrade flow in MCA occlusion.

Abstract

Background/Aims: Vascular territory mapping (VTM) software estimates which intracerebral vessel provides peak arterial flow to a brain voxel. We identify whether VTM software is a determinant of antegrade flow in patients with proximal MCA occlusion. Method(s): Consecutive patients with M1 occlusion were analysed from INSPIRE (International Stroke Perfusion Imaging Registry). Authors reviewed dynamic 4D CTA for the presence an acute M1 thrombus and antegrade flow. VTM software assigned regions of the brain to an estimated feeding vessel (ACA, MCA, PCA). A binomial logistic regression was performed to determine the effects of VTM, ischaemic core (CBF<30) and perfusion lesion (DT>3) on the likelihood that patients had the presence of any antegrade flow in the MCA territory. A secondary analysis was performed to assess the relationship between imaging variables and 3-month MRS outcome. Result(s): The final dataset included 130 patients with M1 occlusion, and 18 patients were identified with antegrade flow on 4D DSA. Patients with antegrade flow had significantly larger VTM MCA volumes, 101ml (72-180), compared to those with complete occlusion, 41ml (21-71). VTM MCA volume significantly predicted antegrade flow, with increase in odds per unit volume (1ml) of 1.024 (95% CI, 1.013 to 1.036), p = <0.001. Ischemic core and the perfusion lesion did not significantly improve model prediction of antegrade flow. Conclusion(s): VTM software was more effective than traditional perfusion parameters in the detection of antegrade flow.