title: Comparison of Imaging Selection Criteria for Intra-Arterial Thrombectomy in Acute Ischemic Stroke with Advanced CT.
abstract: OBJECTIVE
  To compare two selection criteria (noncontrast CT [NCCT] with multi-phase CT Angiography [MPCTA] and CT perfusion [CTP]) for the determination of eligibility for thrombectomy.
  
  
  METHODS
  We retrospectively enrolled 71 patients who underwent head NCCT, 9.6-cm CTP, and craniocervical single-phase CTA (SPCTA) within 6 hours of onset. The simulated MPCTA was reconstructed from 1-mm CTP images for assessment of collateral circulation. Infarct core (relative CBF < 30 %) and penumbra (Tmax > 6 seconds) volumes were measured. The infarct core < 70 mL with a mismatch ratio > 1.2 (CTP-A), infarct core ≤ 40 mL with a mismatch ratio > 1.8 (CTP-B), and ASPECTS > 5 with good collaterals (50 % ≥ MCA territory) were used to determine eligibility for thrombectomy. SPCTA was compared with the simulated MPCTA for assessment of collaterals.
  
  
  RESULTS
  CTP-B determined that 11 patients were ineligible for thrombectomy, of which three were eligible by NCCT with MPCTA and 6 by CTP-A. CTP-A and CTP-B showed discrepancy in determining eligibility for thrombectomy between NCCT with MPCTA in three patients each, rendering no significant statistical difference (P > 0.05). The number of patients with poor collaterals was significantly higher on SPCTA than MPCTA (n = 22 and 6 respectively; P < 0.0001).
  
  
  CONCLUSIONS
  The two imaging selection criteria (NCCT with MPCTA and CTP) were statistically comparable for determining eligibility for thrombectomy.
  
  
  CONCLUSIONS
  • Early mechanical thrombectomy improves clinical outcomes. • Noncontrast CT-multi-phase CTA is used for determining eligibility for thrombectomy. • CTP can help to select patients who are eligible for thrombectomy. • Noncontrast CT-multi-phase CTA and CTP are comparable for patient selection. • Multi-phase CTA is more accurate than single-phase CTA for assessment of collaterals.
authors.affiliation: Department of Radiology, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea. neuroradkim@gmail.com.
authors.forename: Eung Yeop
authors.identifier: http://orcid.org/0000-0002-9579-4098
authors.initials: EY
authors.lastname: Kim
authors.affiliation: Department of Neurology, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Shin
authors.affiliation: Department of Neurology, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Young
authors.initials: Y
authors.lastname: Noh
authors.affiliation: Department of Radiology, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea.
authors.forename: Byeong Ho
authors.initials: BH
authors.lastname: Goh
authors.affiliation: Department of Neurology, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Yeong-Bae
authors.initials: YB
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging; D002533:Cerebral Angiography / Q000379:methods*; D002560:Cerebrovascular Circulation; D000072226:Computed Tomography Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D018579:Patient Selection; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000601:surgery; D017131:Thrombectomy
keywords: CT; CT angiography; CT perfusion; Ischemic stroke; Thrombectomy