Relative Mean Transit Time Predicts Subsequent Stroke in Symptomatic Carotid Occlusion

Robert L Grubb; Colin P Derdeyn; Tom O Videen; David A Carpenter; William J Powers

doi:10.1016/j.jstrokecerebrovasdis.2015.12.041

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Relative Mean Transit Time Predicts Subsequent Stroke in Symptomatic Carotid Occlusion

Journal article

Peer reviewed

Relative Mean Transit Time Predicts Subsequent Stroke in Symptomatic Carotid Occlusion

Robert L Grubb, Colin P Derdeyn, Tom O Videen, David A Carpenter and William J Powers

Journal of stroke and cerebrovascular diseases, Vol.25(6), pp.1421-1424

06/2016

DOI: 10.1016/j.jstrokecerebrovasdis.2015.12.041

PMID: 27021040

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Abstract

Mean transit time (MTT) measurements to assess cerebral hemodynamics are easily obtained by computed tomography and magnetic resonance imaging. We reviewed hemodynamic and clinical outcome data from the St. Louis Carotid Occlusion Study to determine if increased MTT was associated with an increased risk of stroke in patients with symptomatic complete carotid artery occlusion. Positron emission tomography (PET) studies of cerebral blood volume-to-cerebral blood flow ratios were used to calculate MTTs. Mean ipsilateral (side of the occluded internal carotid artery)-to-contralateral ratios of MTTs in the middle cerebral artery territories were determined. MTT was tested as a predictor of stroke risk using Cox regression analysis. Receiver operating characteristic curves for stroke risk prediction were generated by varying the mean ispilateral-to-contralateral MTT ratio to identify an optimal cutpoint. Increased MTT ratio was associated with an increased risk of ipsilateral stroke (P < .001). The maximum combination of sensitivity (.778) and specificity (.763) was obtained at a cutpoint ratio of 1.387 or higher. Subjects with a MTT ratio of 1.387 or higher had a 29.3% 2-year risk of ipsilateral stroke compared to 4.6% for those without (P < .001). PET relative MTT ratio identified patients with symptomatic complete internal artery occlusion who were at high risk for subsequent ipsilateral stroke. Confirmation using measurements of relative MTT from other imaging modalities in a patient cohort receiving contemporary medical management is needed.

internal carotid artery occlusion

stroke risk

Positron emission tomography

mean transit time

Details

Title: Subtitle: Relative Mean Transit Time Predicts Subsequent Stroke in Symptomatic Carotid Occlusion
Creators: Robert L Grubb - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
Colin P Derdeyn - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
Tom O Videen - Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
David A Carpenter - Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
William J Powers - Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
Resource Type: Journal article
Publication Details: Journal of stroke and cerebrovascular diseases, Vol.25(6), pp.1421-1424
DOI: 10.1016/j.jstrokecerebrovasdis.2015.12.041
PMID: 27021040
NLM abbreviation: J Stroke Cerebrovasc Dis
ISSN: 1052-3057
eISSN: 1532-8511
Publisher: Elsevier Inc
Grant note: Charles A. Dana Foundation NS28947; AG05681; AG03991; RR000036 / National Institutes of Health (http://dx.doi.org/10.13039/100000002)
Language: English
Date published: 06/2016
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984020649702771

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