Diluted Contrast-enhanced Cone-beam CT during Acute-phase Recanalization Therapy for Occlusion of the Middle Cerebral Artery

Abstract

We here report the methods for and efficacy of C-arm cone-beam CT (CBCT) with diluted contrast medium during the recanalization therapy in acute ischemic stroke patients with middle cerebral artery occlusion. Case Presentation: The subjects were 30 patients who underwent recanalization therapy for acute ischemic stroke with occlusion of the middle cerebral artery at our hospital between January 2015 and December 2016. Utilizing leptomeningeal anastomosis (LMA), 20-second CBCT with fourfold diluted contrast medium was performed, and 3D image processing was subsequently conducted. In 25 (83.3%) of the 30 patients, a blood vessel distal to the site of occlusion and the extent of thrombus were favorably visualized. Conclusion: This procedure may be useful as an auxiliary examination that provides more detailed information to safely perform recanalization therapy for acute occlusion of the middle cerebral artery through the visualization of a blood vessel distal to the site of the occlusion.

Image Quality and Radiation Dose of Conventional and Wide-Field High-Resolution Cone-Beam Computed Tomography for Cerebral Angiography: A Phantom Study

“…Regarding image reconstruction conditions in AIS-CBCT, Iwasaki et al reported the usefulness of reconstructed images with a 256 × 256 matrix [17]. As AIS-CBCT images require the assessment of the lumen of major vessels and perforators, it is necessary to acquire images with the highest possible spatial resolution.…”

“…In summary, in recent years, the usefulness of mechanical thrombectomy for AIS has been widely reported, and AIS-CBCT has become an essential imaging tool [16,17]. The INR procedures, including mechanical thrombectomy, tend to be complex and may sometimes increase the fluoroscopy time and resultant radiation doses to both the patients and staff [47][48][49][50][51][52][53][54][55][56][57][58][59][60].…”

“…The high-resolution CBCT (HR CBCT) in cerebral angiography is useful for evaluating the intracranial stent expansion in cases of stent-assisted coil embolization and for visualization of the intracranial major/microvessels [13][14][15]. The HR CBCT with contrast media in patients with acute ischemic stroke (AIS-CBCT) is an efficient method owing to its ability to visualize the vessels distal to the occlusion site and the collateral vessels [16,17]. The conventional HR CBCT (C-HR CBCT) has a limited field of view (FOV) with a diagonal size of 22 cm; however, a 27-cm diagonal wide-area HR CBCT (W-HR CBCT) is available and expected to be clinically useful.…”