Abstract T P22: Intra-Aortic Cone-Beam CT Can Shorten Puncture To Treatment Time In Acute Thrombectomy For Acute Ischemic Stroke Patients

Abstract

Background and purpose: Conventional angiographic assessment of collateral blood flow for internal carotid artery (ICA) or basilar artery (BA) occlusion requires contralateral ICA angiography and posterior circulation angiography. The angiography of other vessels may cause time delay for endovascular therapy (EVT) in acute ischemic stroke patients. In this study, we performed intra-aortic cone-beam CT (Ao-CBCT) for assessment of collateral blood flow and analyzed visualization of collateral flow and elapsed time in EVT compare with conventional angiographic assessment. Methods: From July 2010 to July 2014, patients with ICA or BA occlusion among fifty seven acute ischemic stroke patients treated by EVT were enrolled. The subjects were divided into 2 groups; conventional angiography (CA) group and Ao-CBCT group. Ao-CBCT images were acquired in 20 seconds rotational scan. Contrast medium was injected from ascending aorta with 1mL/s for a total of 30 seconds by use of a 4F or 6F catheter and an imaging delay of 10 seconds. We compared patient characteristics, visualization of collateral flow and time from groin puncture to injection from guiding catheter to treatment target vessel (“puncture to treatment” time). Results: Twelve patients in CA group and 4 patients in Ao-CBCT group were analyzed. There was no difference in age, sex, stroke subtypes and occlusion vessel between two groups. In CA group, in addition to target vessel angiography, 2 vessels angiography (interquartile range [IQR], 1-2) were performed. Three patients in CA group were performed Ao-CBCT simultaneously. Collateral blood flow from anterior/posterior communicating artery was equally visualized by both methods. Puncture to treatment time was significantly shorter in Ao-CBCT group than in CA group (21±13 vs. 51±18 minutes, p=0.0087). Conclusions: Ao-CBCT can visualize collateral blood flow in major vessel occlusion and shorten puncture to treatment time compare with conventional angiography.