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European Radiology
Published in: European Radiology 9/2016

01-09-2016 | Neuro

Comparison of Imaging Selection Criteria for Intra-Arterial Thrombectomy in Acute Ischemic Stroke with Advanced CT

Authors: Eung Yeop Kim, Dong Hoon Shin, Young Noh, Byeong Ho Goh, Yeong-Bae Lee

Published in: European Radiology | Issue 9/2016

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Abstract

Objectives

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.

Methods

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.

Results

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).

Conclusion

The two imaging selection criteria (NCCT with MPCTA and CTP) were statistically comparable for determining eligibility for thrombectomy.

Key Points

• 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.
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Metadata
Title
Comparison of Imaging Selection Criteria for Intra-Arterial Thrombectomy in Acute Ischemic Stroke with Advanced CT
Authors
Eung Yeop Kim
Dong Hoon Shin
Young Noh
Byeong Ho Goh
Yeong-Bae Lee
Publication date
01-09-2016
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 9/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-4141-1

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