Single Centre Experience on Decision Making for Mechanical Thrombectomy Based on Single-Phase CT Angiography by Including NCCT and Maximum Intensity Projection Images – A Comparison with Magnetic Resonance Imaging after Non-Contrast CT

Abstract

The purpose of this study was to suggest that computed tomography angiography (CTA) is valuable as the only preliminary examination for mechanical thrombectomy (MT). MT after single examination of CTA including noncontrast computed tomography (NCCT) and maximum intensity projection (MIP) improves door-to-puncture time as well as results in favorable outcomes. Methods : A total of 157 patients who underwent MT at Dong Kang Medical Center from April 2015 to March 2019 were divided into two groups based on the examination performed prior to MT : CTA group who underwent CTA with NCCT and MIP, and NCCT+magnetic resonance image (MRi) group who underwent MRI including perfusion images after NCCT. In the two groups, time to CTA imaging or NCCT+MRi imaging after symptom onset, and time to arterial puncture and reperfusion were characterized as time-related outcomes. The evaluation of vascular recanalization after MT was defined as a modified thrombolysis in cerebral infarction (mTICI) scale. National Institutes of Health Stroke Scale (NIHSS) was assessed at the time of the visit to the emergency room and modified Rankin Scale (mRS) was assessed after 90 days. Results : Typically, there were 34 patients in the CTA group and 33 patients in the NCCT+MRi group. A significantly shorter delay for door-to-puncture time was observed (mean, 86±22.1 vs. 176±47.5 minutes; <0.01). Also, a significantly shorter door-to-imege time in the CTA group was observed (mean, 13±6.8 vs. 93±30.8 minutes; p<0.01). Moreover, a significantly shorter onset-to-puncture time was observed (mean, 195±128.0 vs. 314±157.6 minutes; p<0.01). Reperfusion result of mTICI ≥2b was 100% (34/34) in the CTA group and 94% (31/33) in the NCCT+MRi group, and mTICI 3 in 74% (25/34) in the CTA group and 73% (24/33) in the NCCT+MRi group. Favorable functional outcomes (mRS score ≤2 at 90 days) were 68% (23/34) in the CTA group and 60% (20/33) in the NCCT+MRi group. Conclusion : A single-phase CTA including NCCT and MIP images was performed as a single preliminary examination, which led to a reduction in the time of the procedure and resulted in good results of prognosis. Consequently, it is concluded that this method is of sufficient value as the only preliminary examination for decision making.

Impact of stroke imaging selection modality on endovascular thrombectomy outcomes in the early and extended time windows: A meta‐analysis

“…Following the removal of duplicates and screening of titles and abstracts, 165 studies were subjected to full‐text review. To avoid heterogeneity in outcome estimates, 14 studies (Bouslama et al., 2017 ; Chalouhi et al., 2013 ; Dekker et al., 2021 ; Fischer et al., 2022 ; Garcia‐Esperon et al., 2023 ; Kim & Kim, 2020 ; Koneru et al., 2018 ; Krebs et al., 2022 ; Leslie et al., 2016 ; Lin et al., 2020 ; Prabhakaran et al., 2014 ; Provost et al., 2019 ; Sheth et al., 2013 ; Vagal et al., 2016 ) that compared the outcomes of patients who received EVT with the use of advanced imaging versus basic imaging were excluded from the meta‐analysis due to variability in treatment time windows. Furthermore, a study (Kim et al, 2019 ) that compared the results of diagnosis using advanced imaging versus basic imaging in patients with AIS‐LVO undergoing endovascular therapy, including arterial thrombolysis, was also excluded.…”

Enhancing the clinical value of single-phase computed tomography angiography in the assessment of collateral circulation in acute ischemic stroke: A narrative review

“…Thus, this research indicates that the link between collateral circulation and functional results is not significantly affected by the duration of image acquisition, thereby confirming the imaging efficacy and extensive accessibility of sCTA. [ 46 47 ] In a study conducted by Kim and Kim,[ 48 ] preoperative examinations for 157 patients having mechanical thrombectomy (MT); isCTA-MIP→is sCTA MIP(maximal intensity projection, MIP) and noncontrast CT + magnetic resonance imaging (MRI) were compared. The results verified that sCTA had adequate predictive value as a single preliminary examination before MT, resulting in a shorter examination-to-operation procedure time and a favorable prognosis.…”