Visualization of the Anterior Temporal Artery as a Predictor of Outcome in Middle Cerebral Artery Occlusion Patients Achieving Successful Recanalization After Transfer

Jonathan M Parish; Jeremy B Rhoten; Dale Strong; Tanushree Prasad; Andrew Hines; Joe D Bernard; Jonathan Clemente; Rahul Karamchandani; Andrew W Asimos; William R Stetler

doi:10.7759/cureus.25173

Visualization of the Anterior Temporal Artery as a Predictor of Outcome in Middle Cerebral Artery Occlusion Patients Achieving Successful Recanalization After Transfer

Cureus. 2022 May 20;14(5):e25173. doi: 10.7759/cureus.25173. eCollection 2022 May.

Authors

Affiliations

¹ Neurological Surgery, Carolina Neurosurgery & Spine Associates, Charlotte, USA.
² Neurological Surgery, Carolinas Medical Center, Charlotte, USA.
³ Neurology, Atrium Health, Charlotte, USA.
⁴ Information and Analytics Services, Atrium Health, Charlotte, USA.
⁵ Interventional Radiology, Charlotte Radiology, Charlotte, USA.
⁶ Radiology, Charlotte Radiology, Charlotte, USA.
⁷ Emergency Medicine, Atrium Health, Charlotte, USA.

Abstract

Introduction Anterior temporal artery (ATA) visualization on computed tomography angiography (CTA) has been previously associated with good outcomes in middle cerebral artery (MCA) occlusions, but not in the setting of patients who initially present to non-thrombectomy centers. Methods We retrospectively identified acute MCA (M1) occlusion patients who underwent mechanical thrombectomy after transfer from non-thrombectomy-capable centers. Neuroradiologists confirmed the MCA (M1) as the most proximal site of occlusion on CTA and assessed for visualization of the ATA. Thrombolysis in Cerebral Infarction (TICI) 2b or greater revascularization scores were confirmed by neurointerventionalists blinded to patient outcomes. Ninety-day modified Rankin scale (mRS) scores were obtained via a structured telephone questionnaire. Results We identified 102 M1 occlusion patients over a three-and-a-half-year period presenting to a non-thrombectomy-capable center who underwent transfer and mechanical thrombectomy. There were no significant differences in age, gender, race, comorbidities, or median National Institute of Health Stroke Scale (NIHSS) scores between the ATA visualized (n = 47) versus non-visualized (n = 55) cohort, and no significant differences in baseline Alberta Stroke Program Early Computed Tomography (ASPECT) scores, post-intervention TICI scores, or interval from last known well to revascularization. There was a strong trend in functional independent outcome (mRS ≤ 2) for patients with ATA visualization (63.8% vs. 45.5%, p = 0.064). Conclusion For patients presenting to non-thrombectomy centers without CT perfusion capability, ATA visualization should be further investigated as an outcome predictor, given its association with functional independence after successful recanalization. This article was previously presented as a meeting abstract at the 2021 International Stroke Conference on March 17-19, 2021.

Keywords: cerebral perfusion imaging; computed tomography angiography; neuroimaging; stroke; thrombectomy.