Abstract
BackgroundDynamic axial computed tomographic angiography (dynax–CTA), covering a thin width, with a focus on the bilateral middle cerebral artery (MCA), can quickly visualize the internal carotid artery (ICA) or MCA occlusion. We aimed to investigate whether dynax–CTA appropriately evaluated the collateral status coupled with the upper limit of the onset-to-reperfusion (OtR) time to achieve a major neurological improvement (MNI) at a 24-h follow-up examination after mechanical thrombectomy (MT).MethodsWe included acute ischemic stroke patients admitted from 2018 to 2020 who underwent dynax–CTA on admission and emergent MT for ICA or MCA occlusion. We performed dynax–CTA using an 80-row CT scanner and acquired 25 volume scans, consisting of 40 images of 1-mm thickness and 4-cm width. We classified the collateral status as good, intermediate, and poor based on MCA branch opacification. We evaluated the collateral status and the upper OtR time limit to achieve MNI.ResultsForty-eight patients met our inclusion criteria. Dynax–CTA findings demonstrated MCA and ICA occlusion in 30 and 18 patients, respectively. The collateral status was good, intermediate, and poor in four, 25, and 19 patients, respectively. The upper limits of the OtR time for MNI were 3.63, 8.08, and 8.67 h in patients with poor, intermediate, and intermediate or good collateral status, respectively.ConclusionsDynax–CTA appropriately evaluated the collateral status coupled with the upper limit of the OtR time before performing MT.
Highlights
Dynamic axial computed tomographic angiography, covering a thin width, with a focus on the bilateral middle cerebral artery (MCA), can quickly visualize the internal carotid artery (ICA) or MCA occlusion
The infarct volume was measured with the use of vendor-specific automated software [4], and it remains difficult to know the upper limit of the OtR time based on perfusion CT images on admission
In cases where dynax–computed tomographic angiography (CTA) with a short processing time and without a vendor-specific software can provide an appropriate collateral flow status coupled with the OtR time for mechanical thrombectomy (MT), it could be a useful method in many facilities
Summary
Dynamic axial computed tomographic angiography (dynax–CTA), covering a thin width, with a focus on the bilateral middle cerebral artery (MCA), can quickly visualize the internal carotid artery (ICA) or MCA occlusion. Dynamic axial CTA (dynax–CTA), instead of covering the whole head, covers a 4-cm width with a focus on the middle cerebral artery (MCA) axis, reduces the volumetric data generated, and shortens the processing time of dynamic CTA. The infarct volume was measured with the use of vendor-specific automated software [4], and it remains difficult to know the upper limit of the OtR time based on perfusion CT images on admission. In cases where dynax–CTA with a short processing time and without a vendor-specific software can provide an appropriate collateral flow status coupled with the OtR time for MT, it could be a useful method in many facilities
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