Abstract
Purpose: RAPID LVO (RLVO) automatically detects anterior circulation large vessel occlusion (LVO) by quantifying MCA territory relative vessel density (RVD) compared to the contralateral side, allowing early mobilization of treatment teams. We present our one year experience in a multihospital health system for LVO detection in patients with stroke symptoms, effect on treatment time and clinical outcomes. Materials/Methods: The study was supervised by the local IRB. 1203 patients presenting with stroke symptoms receiving CTAs with RLVO were included. RLVO exams were positive at RVD < 60% (red or yellow color) and negative at RVD >60%. Radiology exams were positive if LVO (ICA/M1or M2 occlusion) or high grade stenosis (HGS) was found. All positive cases were reviewed by a second reader with 100% concordance. Expert reads were used as the gold standard and sensitivity, specificity, PPV (positive predictive value) and NPV (negative predictive value) were calculated. Patients eligible for mechanical thrombectomy (MT) were transferred to a comprehensive stroke center for treatment. CTA to groin puncture time was calculated during one year time intervals before and after RLVO installation for patients undergoing MT. 90 day Modified Rankin Scores (mRS) were obtained. Results: 126 patients had M1/ICA occlusion, 71 had M2 occlusion, and 134 had HGS of the ICA or MCA. RLVO had sensitivities of 90%, 82%, and 82%, specificities of 82%, 85%, and 95%, PPV of 37%, 52%, and 87% and NPV of 99%, 96%, and 93% in the detection of M1 occlusion, LVO, or HGS/LVO, respectively. CTA to groin puncture time was significantly lower after deployment of RLVO (93 minutes vs 68 minutes, p<0.05). Average 90 day mRS was lower with RLVO with a higher percentage of patients with functional independence (mRS ≤ 2) (p<0.05). Conclusion: RLVO detected HGS or LVO in patients presenting with stroke symptoms with high accuracy. After RLVO installation, time to treatment decreased and clinical outcomes were improved.
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