Predictive value of computed tomography angiography-determined occlusion type in stent retriever thrombectomy

Selected in Stroke by Rodrigo RIVERA

Authors: Baek JH, Kim BM, Yoo J, Nam HS, Kim YD, Kim DJ, Heo JH, Bang OY

Reference: Stroke. 2017 Oct;48(10):2746-2752

Published: October 2017

Monday 16 October 2017
Rodrigo RIVERA

The great success rate of mechanical thrombectomy in intracranial large vessel occlusions sometimes confronts failure due to thrombus characteristics. There is a considerable difference in revascularization of an embolus vs a complicated atheromatous plaque. 
The authors of this work explored the predictive value of CT angiography for telling, prior to treatment, the type of occlusion and the rate to success.

For this purpose, they studied 238 patients with ICA, M1, vertebral or basilar artery occlusions. They divided cases in two types depending on CTA morphology. A truncal type, usually linked to atheromatosis origin or a branching type, often due to embolic etiology. They also looked for atrial fibrillation (AF) and hyperdense artery sign.
They compared CTA with DSA, that served as the gold standard for defining occlusion type. CTA was able to predict recanalization rate showing significant differences if the pattern was truncal type (low recanalization) or branching type (high possibility of revascularization). Moreover, CTA was better predictor of success than AF or hiperdense artery at CT.

The value of these results is that with using mono phase CTA protocol, there is a strong possibility to have important information about clot characteristics. And, it could lead to better planning of the neurointerventional procedure. In example, if the CTA shows truncal type, pointing to atheromatosis etiology, recanalization could be focused to add angioplasty, antiplatelet therapy or stenting in order to recanalise and keep the vessel open.

As authors state, this method could be improved using double phase CTA, leading to better understanding of collaterals and branch situation. Thus, with the shown method, results could be really important and useful in daily practice.

Rodrigo Rivera, MD
Neuroradiology Department
Instituto de Neurocirugia Dr. Asenjo
Santiago, Chile

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