Abstract W P2: Intra-arterial Contrasted Cone-beam CT Assessment of Occluded Distal Vessels in Acute Ischemic Stroke Patients with Major Vessel Occlusion
Background and Purpose: Identifying the information of occluded distal vessels is quite important for making a suitable selection of treatment strategy and devices in endovascular revascularization therapy (EVT) for acute ischemic stroke patients. It has been demonstrated that intra-venous cone-beam CT (IV-CBCT) is able to visualize distally of the occluded vessels. In this study, intra-arterial contrasted high-resolution cone-beam CT from ascending aorta (Ao-CBCT) was newly introduced for the visualization of occluded distal vessels and its clinical values were assessed
Methods: Acute ischemic stroke patients with major vessel occlusion planed EVT were evaluated. Adaption of EVT was decided by using MRI/MRA assessment in advance. In endovascular procedure, digital subtraction angiography (DSA) and Ao-CBCT were performed to evaluate occluded site, collaterals and occluded distal vessels with local anesthesia. 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 assessed the image quality of Ao-CBCT and compared in the visualization of occluded distal vessels among MRA, DSA and Ao-CBCT.
Results: We analyzed 14 patients (mean age, 66 years. 3 female patients), respectively. Stroke subtypes were cardiogenic (n=6), atherothrombotic (n=5) and others/unknown (n=3). Occluded site were MCA M1 (n=8), MCA M2 (n=2), ICA (n=2), MCA M4 (n=1) and BA (n=1). All obtained Ao-CBCT images could evaluate occlusion distal vessels successfully and 11 images (79%) were excellent. In all cases, Ao-CBCT images could depict occluded distal vessels more detailed than MRA and DSA.
Conclusions: Ao-CBCT is an efficient method to obtain the detailed information of occluded vessels compared with conventional examination methods. It requires less contrast agent compared to IV-CBCT, while maintaining enough information to determine treatment strategy.
Author Disclosures: T. Amano: None. M. Sato: None. K. Mori: None. Y. Matsumaru: None. Y. Hamada: None.
- © 2014 by American Heart Association, Inc.