Mechanical thrombectomy using a combined CT/C-arm X-ray system.
BACKGROUND
Mechanical thrombectomy (MT) using stent-retrievers has been proven to be a safe and effective treatment in acute ischemic stroke (AIS), particularly in large vessel occlusion. Other than patient characteristics, time to recanalization is the most important factor linked to outcome. MT is usually performed in a dedicated angiography suite using a floor- and/or ceiling-mounted biplane angiographic system. Here we report our first experience of MT with a new combined CT and mobile C-arm X-ray device setup.


METHODS
Patients with AIS underwent stroke imaging (non-contrast enhanced CT, CT perfusion, and CT angiography) using a commercially available 64-slice CT scanner which was modified for combined use with a C-arm system. In patients with large vessel occlusion, MT was conducted without further patient transfer within the CT imaging suite using a mobile C-arm X-ray device equipped with a 30×30 cm (12×12 inch), 1.5×1.5 k full-view flat detector which was positioned between the gantry and patient table. The safety and feasibility of this new system was assessed in preliminary patients.


RESULTS
Angiographic imaging quality of the mobile C-arm was feasible and satisfactory for diagnostic angiography and MT. Using this setup, time between stroke imaging and groin puncture (picture-to-puncture time) was reduced by up to 35 min (including time for preparation of the patient such as intubation).


CONCLUSIONS
MT using a combined CT/C-arm system is safe and feasible. The potential advantages, particularly time saving and ensuing improvement in patient outcome, need to be assessed in a larger study.
Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany.
Johannes
http://orcid.org/0000-0003-0672-5718
J
Pfaff
Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany.
Christian
C
Herweh
Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany.
Mirko
M
Pham
Department of Neurology, University of Heidelberg, Heidelberg, Germany.
Silvia
S
Schönenberger
Department of Neurology, University of Heidelberg, Heidelberg, Germany.
Julian
J
Bösel
Department of Neurology, University of Heidelberg, Heidelberg, Germany.
Peter A
PA
Ringleb
Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany.
Sabine
S
Heiland
Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany.
Martin
M
Bendszus
Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany.
Markus
M
Möhlenbruch
D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015424:Reperfusion; D020521:Stroke / Q000000981:diagnostic imaging / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014965:X-Rays
Angiography; CT; Stroke; Technology; Thrombectomy