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

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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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Abbreviations

ASPECTS:

Alberta Stroke Program Early CT Score

CBF:

Cerebral blood flow

CTDI:

CT dose index

CTP:

Perfusion CT

DLP:

Dose length product

ICA:

Internal carotid artery

IQR:

Interquartile range

MCA:

Middle cerebral artery

MPCTA:

Multi-phase CT angiography

NCCT:

Noncontrast CT

SPCTA:

Single-phase CT angiography

Tmax:

Time to maximum

tPA:

Tissue plasminogen activator

VPCT:

Volumetric perfusion CT

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Acknowledgements

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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Authors and Affiliations

  1. Department of Radiology, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea

    Eung Yeop Kim & Byeong Ho Goh

  2. Department of Neurology, Gachon University Gil Medical Center, Incheon, Korea

    Dong Hoon Shin, Young Noh & Yeong-Bae Lee

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  1. Eung Yeop Kim
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  2. Dong Hoon Shin
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  3. Young Noh
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  4. Byeong Ho Goh
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Correspondence to Eung Yeop Kim.

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Kim, E.Y., Shin, D.H., Noh, Y. et al. Comparison of Imaging Selection Criteria for Intra-Arterial Thrombectomy in Acute Ischemic Stroke with Advanced CT. Eur Radiol 26, 2974–2981 (2016). https://doi.org/10.1007/s00330-015-4141-1

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  • DOI: https://doi.org/10.1007/s00330-015-4141-1

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