Comparison of Imaging Selection Criteria for Intra-Arterial Thrombectomy in Acute Ischemic Stroke with Advanced CT
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To compare two selection criteria (noncontrast CT [NCCT] with multi-phase CT Angiography [MPCTA] and CT perfusion [CTP]) for the determination of eligibility for thrombectomy.
We retrospectively enrolled 71 patients who underwent head NCCT, 9.6-cm CTP, and craniocervical single-phase CTA (SPCTA) within 6 hours of onset. The simulated MPCTA was reconstructed from 1-mm CTP images for assessment of collateral circulation. Infarct core (relative CBF < 30 %) and penumbra (Tmax > 6 seconds) volumes were measured. The infarct core < 70 mL with a mismatch ratio > 1.2 (CTP-A), infarct core ≤ 40 mL with a mismatch ratio > 1.8 (CTP-B), and ASPECTS > 5 with good collaterals (50 % ≥ MCA territory) were used to determine eligibility for thrombectomy. SPCTA was compared with the simulated MPCTA for assessment of collaterals.
CTP-B determined that 11 patients were ineligible for thrombectomy, of which three were eligible by NCCT with MPCTA and 6 by CTP-A. CTP-A and CTP-B showed discrepancy in determining eligibility for thrombectomy between NCCT with MPCTA in three patients each, rendering no significant statistical difference (P > 0.05). The number of patients with poor collaterals was significantly higher on SPCTA than MPCTA (n = 22 and 6 respectively; P < 0.0001).
The two imaging selection criteria (NCCT with MPCTA and CTP) were statistically comparable for determining eligibility for thrombectomy.
• Early mechanical thrombectomy improves clinical outcomes.
• Noncontrast CT–multi-phase CTA is used for determining eligibility for thrombectomy.
• CTP can help to select patients who are eligible for thrombectomy.
• Noncontrast CT–multi-phase CTA and CTP are comparable for patient selection.
• Multi-phase CTA is more accurate than single-phase CTA for assessment of collaterals.
KeywordsIschemic stroke CT CT angiography CT perfusion Thrombectomy
Alberta Stroke Program Early CT Score
Cerebral blood flow
CT dose index
Dose length product
Internal carotid artery
Middle cerebral artery
Multi-phase CT angiography
Single-phase CT angiography
Time to maximum
Tissue plasminogen activator
Volumetric perfusion CT
The scientific guarantor of this publication is EYK. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding by a grant from Dongkook Pharmaceutical (for EYK), and by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI14C1135) (for YN). No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. No study subjects or cohorts have been previously reported elsewhere. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.
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