Velocity Curvature Index: a Novel Diagnostic Biomarker for Large Vessel Occlusion
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ORIGINAL ARTICLE
Velocity Curvature Index: a Novel Diagnostic Biomarker for Large Vessel Occlusion Samuel G. Thorpe 1 & Corey M. Thibeault 1 & Seth J. Wilk 1 & Michael O’Brien 1 & Nicolas Canac 1 & Mina Ranjbaran 1 & Christian Devlin 2 & Thomas Devlin 3 & Robert B. Hamilton 1 Received: 7 June 2018 / Revised: 6 August 2018 / Accepted: 24 September 2018 # The Author(s) 2018
Abstract Despite being a conveniently portable technology for stroke assessment, Transcranial Doppler ultrasound (TCD) remains widely underutilized due to complex training requirements necessary to reliably obtain and interpret cerebral blood flow velocity (CBFV) waveforms. The validation of objective TCD metrics for large vessel occlusion (LVO) represents a first critical step toward enabling use by less formally trained personnel. In this work, we assess the diagnostic utility, relative to current standard CT angiography (CTA), of a novel TCD-derived biomarker for detecting LVO. Patients admitted to the hospital with stroke symptoms underwent TCD screening and were grouped into LVO and control groups based on the presence of CTA confirmed occlusion. Velocity curvature index (VCI) was computed from CBFV waveforms recorded at multiple depths from the middle cerebral arteries (MCA) of both cerebral hemispheres. VCI was assessed for 66 patients, 33 of which had occlusions of the MCA or internal carotid artery. Our results show that VCI was more informative when measured from the cerebral hemisphere ipsilateral to the site of occlusion relative to contralateral. Moreover, given any pair of bilateral recordings, VCI separated LVO patients from controls with average area under receiver operating characteristic curve of 92%, which improved to greater than 94% when pairs were selected by maximal velocity. We conclude that VCI is an analytically valid candidate biomarker for LVO diagnosis, possessing comparable accuracy, and several important advantages, relative to current TCD diagnostic methodologies. Keywords Ischemic stroke . Transcranial Doppler . Ultrasound . Diagnostic imaging . Large vessel occlusion
Introduction Acute ischemic stroke (AIS) is the leading cause of long-term disability in the USA, accounting for 87% of ~ 795,000 annual US stroke cases [1]. Intravenous tissue plasminogen activator (IV-tPA) often fails to prevent negative outcomes, even when expediently administered [2, 3]. Recent advances in neurointerventional therapies provide superior treatment
* Samuel G. Thorpe [email protected] 1
Neural Analytics, Inc., 2440 S. Sepulveda Blvd. Suite 115, Los Angeles, CA 90064, USA
2
Cardiac Biomechanics Group, University of Virginia, Charlottesville, VA, USA
3
Department of Neurology, Erlanger Medical Center, Chattanooga, TN, USA
options for large vessel occlusions (LVO), but can be limited in effectiveness if not performed within a short window after symptom onset; yielding diminishing therapeutic returns with each subsequent hour [4–6]. Although significant efforts have been undertaken to educate the public and medi
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