title: Does preinterventional flat-panel computer tomography pooled blood volume mapping predict final infarct volume after mechanical thrombectomy in acute cerebral artery occlusion?
abstract: OBJECTIVE
  Decreased cerebral blood volume is known to be a predictor for final infarct volume in acute cerebral artery occlusion. To evaluate the predictability of final infarct volume in patients with acute occlusion of the middle cerebral artery (MCA) or the distal internal carotid artery (ICA) and successful endovascular recanalization, pooled blood volume (PBV) was measured using flat-panel detector computed tomography (FPD CT).
  
  
  METHODS
  Twenty patients with acute unilateral occlusion of the MCA or distal ACI without demarcated infarction, as proven by CT at admission, and successful Thrombolysis in cerebral infarction score (TICI 2b or 3) endovascular thrombectomy were included. Cerebral PBV maps were acquired from each patient immediately before endovascular thrombectomy. Twenty-four hours after recanalization, each patient underwent multislice CT to visualize final infarct volume. Extent of the areas of decreased PBV was compared with the final infarct volume proven by follow-up CT the next day.
  
  
  RESULTS
  In 15 of 20 patients, areas of distinct PBV decrease corresponded to final infarct volume. In 5 patients, areas of decreased PBV overestimated final extension of ischemia probably due to inappropriate timing of data acquisition and misery perfusion.
  
  
  CONCLUSIONS
  PBV mapping using FPD CT is a promising tool to predict areas of irrecoverable brain parenchyma in acute thromboembolic stroke. Further validation is necessary before routine use for decision making for interventional thrombectomy.
authors: Institute of Neuroradiology, Hospital of Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany. marlies.wagner@kgu.de
authors: Marlies
authors: M
authors: Wagner
authors: Yiannis
authors: Y
authors: Kyriakou
authors: Richard
authors: R
authors: du Mesnil de Rochemont
authors: Oliver C
authors: OC
authors: Singer
authors: Joachim
authors: J
authors: Berkefeld
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods; D001931:Brain Mapping; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D002548:Cerebral Revascularization / Q000379:methods; D015331:Cohort Studies; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011300:Preoperative Care / Q000379:methods; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging* / Q000601:surgery; D017131:Thrombectomy / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome