Abstract Details

Title Gaze Deviation on Initial CT as Predictor of Large Vessel Occlusion

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-047

Objective NA

Background

Treatment of large vessel occlusion (LVO) stroke is traditionally preceded by imaging of vessels using computed tomographic angiography (CTA). However, CTA may not be feasible or available. Given this, early LVO signs on initial non-contrast CT could prove practical, such as the hyperdense vessel sign (HVS). We aimed to investigate the sensitivity of another potential indicator of LVO on CT, gaze deviation, and compare it to HVS.

Design/Methods We conducted a retrospective analysis of patients with anterior circulation LVO admitted to a comprehensive stroke center from 2015 to 2018, who underwent endovascular therapy (ET). All patients had LVO on CTA. Initial head CTs were reviewed for HVS and gaze deviation by two neurologists and compared to radiology reports. Two analyses were performed: detection of HVS and gaze deviation by each examiner, diagnostic radiologist with sensitivity calculation; and interrater agreement for identification of HVS and gaze deviation using a Kappa Coefficient between the primary examiners and between diagnostic radiologists.

Results 121 patients were included. Sensitivity of HVS by examiner 1 was 46% and 2 was 60%. Sensitivity of HVS by in-house radiology was 36% and OSH radiology was 27%. Sensitivity of gaze deviation by examiner 1 was 65% and 2 was 79%. Inter-rater reliability of HVS for examiners 1 and 2 had substantial agreement (K=0.64), and for in-house and OSH radiology had fair agreement (K=0.27). Inter-rater reliability of gaze deviation for examiners 1 and 2 had substantial agreement (K=0.69). No radiology report noted gaze deviation, despite 2 reports of unrelated ocular findings.

Conclusions Gaze deviation may be a more reliable indicator of LVO on initial CT than the HVS. This is the largest sample size to examine and compare signs of LVO. More research should be invested in this and other indicators of LVO that can assist in efficient triage of these strokes.

Authors/Disclosures
Jeremy Kulacz, MD (SIU School of Medicine) PRESENTER	Dr. Kulacz has nothing to disclose.
Alejandro Vargas, MD, MS, FAAN (Rush University Medical Center)	Dr. Vargas has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer U.S. LLC Pharmaceuticals.
Laurel J. Cherian, MD, FAAN (Rush University Medical Center)	The institution of Dr. Cherian has received research support from NIH.
James Conners, MD (Rush University Medical Center)	The institution of Dr. Conners has received research support from nih.
Rima Dafer, MD (Rush University Medical Center)	Dr. Dafer has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Dafer has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Eli Lilly. Dr. Dafer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Anderson, Rasor, and partners.
Nicholas D. Osteraas, MD (Rush University Med Center)	Dr. Osteraas has nothing to disclose.
Sarah Song, MD, MPH, FAAN (Rush University Medical Center)	Dr. Song has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN.

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