Introduction/purpose Both CT perfusion (CTP) and Multiphase CTA (MCTA) have been shown to be effective tools for identifying patients with acute ischemic stroke due to a large vessel occlusion who may benefit from thrombectomy (1). While CTP provides more quantifiable information, it requires computationally intensive post-processing power which may not be readily available at many institutions, and this may cause delay in image acquisition and interpretation. MCTA can be performed with three image acquisitions separated by only several seconds, it requires minimal post-processing, and the studies are relatively simple to interpret.
The primary purpose of this study was to compare rates of thrombectomy and clinical outcomes in patients with large vessel occlusion (LVO) who were triaged using MCTA versus those triaged with CTP.
Materials and methods Approval from the institutional review board was obtained. The imaging database was queried for all MCTA and CTP examinations at our comprehensive stroke center. The database was queried for patients undergoing CTP from January 2012 through December 2015 at which point our institution transitioned to MCTA, which has continued to present day. Patients undergoing MCTA were reviewed from August 2016 through the end of 2017. All patients who underwent MCTA or CTP to assess thrombectomy candidacy were included. The studies were reviewed individually for the presence of an LVO.
Rates of LVO and inclusion for thrombectomy were calculated and reviewed. Comparisons of functional independence between our MCTA cohort and that of the DEFUSE 3 trial was made.
Results 227 out of 722 patients who underwent MCTA were found to have a LVO (31%), compared to 162 out of 401 patients who underwent CTP (40%). The rate of inclusion for thrombectomy in the MCTA cohort with LVO (61%) was significantly higher than the CTP cohort (36%; p<0.0001). Successful reperfusion rates (TICI 2B or greater) were similar between CTP and MCTA (86% and 87% respectively). 41% of patients in our MCTA group who underwent thrombectomy were functionally independent (mRS 0–2) at 90 days which is comparable to the rate of 45% in DEFUSE 3.
Conclusion Using multiphase CTA to triage patients with acute ischemic stroke for thrombectomy can lead to a higher thrombectomy rate for patients with LVO compared to CTP with good clinical results.
Disclosures G. Bennett: None. S. Arndt: None. J. Lavie: None. T. Truong: None. G. Vidal: 3; C; Penumbra. J. Milburn: 3; C; Penumbra, Stryker.
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