Top

Published in:

01-04-2012 | Interventional Neuroradiology

Intravenous flat-detector CT angiography in acute ischemic stroke management

Authors: Raphaël Blanc, Silvia Pistocchi, Drazenko Babic, Bruno Bartolini, Michaël Obadia, Sonia Alamowitch, Michel Piotin

Published in: Neuroradiology | Issue 4/2012

Abstract

Introduction

In the settings of stroke, a non-invasive high-resolution imaging modality to visualize the arterial intracranial circulation in the interventional lab is a helpful mean to plan the endovascular recanalization procedure. We report our initial experience with intravenously enhanced flat-detector CT (IV FDCT) technology in the detection of obstructed intracranial arteries.

Methods

Fourteen consecutive patients elected for endovascular stroke therapy underwent IV FDCT. The scans were intravenously enhanced and acquired in accordance with the previously calculated bolus arrival time. Images were processed on a commercially available workstation for reconstructions and 3D manipulation. Occlusion level and clot length, the quality of collateral vessels, and the patency of anterior and posterior communicating arteries were assessed.

Results

IV FDCT was performed successfully in all the cases and allowed for clot location and length visualization, assessment of communicating arteries patency, and evaluation of vessel collateral grade. Information obtained from this technique was considered useful for patients treated by endovascular approach. Retrospective review of the images by two independent readers was considered accurate and reproducible.

Conclusions

IV FDCT technology provided accurate delineation of obstructed vessel segments in acute ischemic stroke disease. It gave a significant help in the interventional strategy. This new technology available in the operating room might provide a valuable tool in emerging endovascular stroke therapy.

Bryan RN (1990) Imaging of acute stroke. Radiology 177(3):615–616PubMed

Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D (2008) Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359(13):1317–1329PubMedCrossRef

Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, Pessin M, Ahuja A, Callahan F, Clark WM, Silver F, Rivera F (1999) Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 282(21):2003–2011PubMedCrossRef

Wolpert SM, Bruckmann H, Greenlee R, Wechsler L, Pessin MS, del Zoppo GJ (1993) Neuroradiologic evaluation of patients with acute stroke treated with recombinant tissue plasminogen activator. The rt-PA Acute Stroke Study Group. AJNR Am J Neuroradiol 14(1):3–13PubMed

Riedel CH, Jensen U, Rohr A, Tietke M, Alfke K, Ulmer S, Jansen O (2010) Assessment of thrombus in acute middle cerebral artery occlusion using thin-slice nonenhanced computed tomography reconstructions. Stroke 41(8):1659–1664PubMedCrossRef

Miley JT, Taylor RA, Janardhan V, Tummala R, Lanzino G, Qureshi AI (2008) The value of computed tomography angiography in determining treatment allocation for aneurysmal subarachnoid hemorrhage. Neurocrit Care 9(3):300–306PubMedCrossRef

Vertinsky AT, Schwartz NE, Fischbein NJ, Rosenberg J, Albers GW, Zaharchuk G (2008) Comparison of multidetector CT angiography and MR imaging of cervical artery dissection. AJNR Am J Neuroradiol 29(9):1753–1760PubMedCrossRef

Mnyusiwalla A, Aviv RI, Symons SP (2009) Radiation dose from multidetector row CT imaging for acute stroke. Neuroradiology. doi:10.1007/s00234-009-0543-6 PubMed

Tomandl BF, Klotz E, Handschu R, Stemper B, Reinhardt F, Huk WJ, Eberhardt KE, Fateh-Moghadam S (2003) Comprehensive imaging of ischemic stroke with multisection CT. Radiographics 23(3):565–592PubMedCrossRef

10.

White PM, Gilmour JN, Weir NW, Innes B, Sellar RJ (2008) AngioCT in the management of neurointerventional patients: a prospective, consecutive series with associated dosimetry and resolution data. Neuroradiology 50(4):321–330. doi:10.1007/s00234-007-0339-5 PubMedCrossRef

11.

Soderman M, Babic D, Holmin S, Andersson T (2008) Brain imaging with a flat detector C-arm: technique and clinical interest of XperCT. Neuroradiology 50(10):863–868PubMedCrossRef

12.

Mordasini P, Al-Senani F, Gralla J, Do DD, Brekenfeld C, Schroth G (2009) The use of flat panel angioCT (DynaCT) for navigation through a deformed and fractured carotid stent. Neuroradiology 52:629–632PubMedCrossRef

13.

Buhk JH, Lingor P, Knauth M (2008) Angiographic CT with intravenous administration of contrast medium is a noninvasive option for follow-up after intracranial stenting. Neuroradiology 50(4):349–354PubMedCrossRef

14.

Qureshi AI (2002) New grading system for angiographic evaluation of arterial occlusions and recanalization response to intra-arterial thrombolysis in acute ischemic stroke. Neurosurgery 50(6):1405–1414, discussion 1414-1405PubMed

15.

Christoforidis GA, Mohammad Y, Kehagias D, Avutu B, Slivka AP (2005) Angiographic assessment of pial collaterals as a prognostic indicator following intra-arterial thrombolysis for acute ischemic stroke. AJNR Am J Neuroradiol 26(7):1789–1797PubMed

16.

Higashida RT, Furlan AJ, Roberts H, Tomsick T, Connors B, Barr J, Dillon W, Warach S, Broderick J, Tilley B, Sacks D (2003) Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke 34(8):e109–e137PubMedCrossRef

17.

Maas MB, Lev MH, Ay H, Singhal AB, Greer DM, Smith WS, Harris GJ, Halpern E, Kemmling A, Koroshetz WJ, Furie KL (2009) Collateral vessels on CT angiography predict outcome in acute ischemic stroke. Stroke 40(9):3001–3005PubMedCrossRef

18.

Puetz V, Dzialowski I, Hill MD, Subramaniam S, Sylaja PN, Krol A, O'Reilly C, Hudon ME, Hu WY, Coutts SB, Barber PA, Watson T, Roy J, Demchuk AM (2008) Intracranial thrombus extent predicts clinical outcome, final infarct size and hemorrhagic transformation in ischemic stroke: the clot burden score. Int J Stroke 3(4):230–236PubMedCrossRef

19.

Bang OY, Saver JL, Kim SJ, Kim GM, Chung CS, Ovbiagele B, Lee KH, Liebeskind DS (2011) Collateral flow predicts response to endovascular therapy for acute ischemic stroke. Stroke 42(3):693–699PubMedCrossRef

20.

Psychogios MN, Buhk JH, Schramm P, Xyda A, Mohr A, Knauth M (2010) Feasibility of angiographic CT in peri-interventional diagnostic imaging: a comparative study with multidetector CT. AJNR Am J Neuroradiol 31(7):1226–1231PubMedCrossRef

21.

Struffert T, Kloska S, Engelhorn T, Deuerling-Zheng Y, Ott S, Doelken M, Saake M, Kohrmann M, Doerfler A (2011) Optimized intravenous flat detector CT for non-invasive visualization of intracranial stents: first results. Eur Radiol 21(2):411–418PubMedCrossRef

22.

Akpek S, Brunner T, Benndorf G, Strother C (2005) Three-dimensional imaging and cone beam volume CT in C-arm angiography with flat panel detector. Diagn Interv Radiol 11(1):10–13PubMed

23.

Snoeren RM, Söderman M, Kroon JN, Roijers RB, de With PH, Babic D (2011) High-resolution 3D X-ray imaging of intracranial nitinol stents.Neuroradiology (in press)

24.

Struffert T, Deuerling-Zheng Y, Kloska S, Engelhorn T, Strother CM, Kalender WA, Kohrmann M, Schwab S, Doerfler A (2010) Flat detector CT in the evaluation of brain parenchyma, intracranial vasculature, and cerebral blood volume: a pilot study in patients with acute symptoms of cerebral ischemia. AJNR Am J Neuroradiol 31(8):1462–1469PubMedCrossRef

25.

Shetty AN, Bis KG, Vyas AR, Kumar A, Anderson A, Balasubramaniam M (2008) Contrast volume reduction with superior vena cava catheter-directed coronary CT angiography: comparison with peripheral i.v. contrast enhancement in a swine model. AJR Am J Roentgenol 190(4):W247–W254PubMedCrossRef

26.

Hatakeyama Y, Kakeda S, Ohnari N, Moriya J, Oda N, Nishino K, Miyamoto W, Korogi Y (2007) Reduction of radiation dose for cerebral angiography using flat panel detector of direct conversion type: a vascular phantom study. AJNR Am J Neuroradiol 28(4):645–650PubMed

Title: Intravenous flat-detector CT angiography in acute ischemic stroke management
Authors: Raphaël Blanc
Silvia Pistocchi
Drazenko Babic
Bruno Bartolini
Michaël Obadia
Sonia Alamowitch
Michel Piotin
Publication date: 01-04-2012
Publisher: Springer-Verlag
Published in: Neuroradiology / Issue 4/2012
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-011-0893-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Intravenous flat-detector CT angiography in acute ischemic stroke management

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2012

Frederik Barkhof, Nick C. Fox, Antonio J. Bastos-Leite and Philip Scheltens: Neuroimaging in dementia. 1st edition

Progressive decline in fractional anisotropy on serial DTI examinations of the corpus callosum: a putative marker of disease activity and progression in SPMS

Social factors influencing hospital arrival time in acute ischemic stroke patients

Segmentation of multiple sclerosis lesions in MR images: a review

Diffuse vascular injury: convergent-type hemorrhage in the supratentorial white matter on susceptibility-weighted image in cases of severe traumatic brain damage

Diagnosis of neuromyelitis optica (NMO) spectrum disorders: is MRI obsolete?