Combined Use of X-ray Angiography and Intraprocedural MRI Enables                    Tissue-based Decision Making Regarding Revascularization during Acute Ischemic                    Stroke Intervention

Narsinh, Kazim; Kilbride, B; Mueller, Kerstin; Murph, Daniel; Copelan, Alexander; Massachi, Jonathan; Vitt, Jeffrey R.; Sun, Chung‐Huan; Bhat, Himanshu; Amans, Matthew R; Dowd, Christopher F.; Halbach, Van V.; Higashida, Randall T.; Moore, Teri; Wilson, Mark W.; Cooke, Daniel L; Hetts, Steven W.

doi:10.1148/radiol.2021202750

Cited by 7 publications

(1 citation statement)

References 29 publications

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“…In cases of incomplete thrombectomy with residual occlusion—for example, the decision whether to perform rescue maneuvers (eg, with distal stent retrievers24 25 or administration of a thrombolytic drug26 27) or to stop, is currently open to discussion. Intraprocedural magnetic resonance may also aid in such real-time treatment decision-making,28 although FD-CT is considerably simpler from a workflow standpoint. FD-CTP could delineate penumbra and infarcted tissue and help to prevent futile (no more salvable brain tissue) or unnecessary angiographic improvement (no infarction would have developed if no rescue maneuver had been performed) 29…”

Section: Discussionmentioning

confidence: 99%

Evaluation of time-resolved whole brain flat panel detector perfusion imaging using RAPID ANGIO in patients with acute stroke: comparison with CT perfusion imaging

Kurmann

Kaesmacher

Cooke

et al. 2022

J NeuroIntervent Surg

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BackgroundIn contrast to conventional CT perfusion (CTP) imaging, flat panel detector CT perfusion (FD-CTP) imaging can be acquired directly in the angiosuite.ObjectiveTo evaluate time-resolved whole brain FD-CTP imaging and assess clinically important qualitative and quantitative perfusion parameters in correlation with previously acquired conventional CTP using the new RAPID for ANGIO software.MethodsWe included patients with internal carotid artery occlusions and M1 or M2 occlusions from six centers. All patients underwent mechanical thrombectomy (MT) with preinterventional conventional CTP and FD-CTP imaging. Quantitative performance was determined by comparing volumes of infarct core, penumbral tissue, and mismatch. Eligibility for MT according to the perfusion imaging criteria of DEFUSE 3 was determined for each case from both conventional CTP and FD-CTP imaging.ResultsA total of 20 patients were included in the final analysis. Conventional relative cerebral blood flow (rCBF) <30% and FD-CTP rCBF <45% showed good correlation (R2=0.84). Comparisons of conventional CTP Tmax >6 s versus FD-CTP Tmax >6 s and CTP mismatch versus FD-CTP mismatch showed more variability (R2=0.57, and R2=0.33, respectively). Based on FD-CTP, 16/20 (80%) patients met the inclusion criteria for MT according to the DEFUSE 3 perfusion criteria, in contrast to 18/20 (90%) patients based on conventional CTP. The vessel occlusion could be correctly extrapolated from the hypoperfusion in 18/20 cases (90%).ConclusionsIn our multicenter study, time-resolved whole brain FD-CTP was technically feasible, and qualitative and quantitative perfusion results correlated with those obtained with conventional CTP.

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