Introduction Dual-energy computed tomography (DECT) has emerged as a promising modality for evaluating patients following mechanical thrombectomy (MT) for acute ischemic stroke. This pictorial overview aims to demonstrate the diagnostic capabilities and clinical implications of DECT in this critical post-procedural phase.

Aim of Study To illustrate the utility of DECT in post-MT patients, highlighting its role in assessing post thrombectomy CT hyperattenuating lesion by delineating post-procedural contrast staining (CS) and haemorrhage transformation, thereby providing an assessment of the grade of underlying blood brain barrier (BBB) disruption.

Methods A retrospective analysis between December 2023 and March 2024 was conducted on a cohort of post-MT patients who underwent DECT imaging after 24 hours post procedure. Imaging data were assessed for underlying CS, HT and established infarct using DECT-derived iodine maps and virtual non-contrast (VNC) images.

Results A total of 61 studies were identified. 8 studies were excluded due to clot resolution on catheter angiogram or clinical deterioration post-MT requiring decompressive craniectomy. Post-MT DECT imaging performed demonstrates ability to delineate areas of parenchymal CS and HT, allowing differentiation between viable and infarcted brain tissue, and thereby enabling treatment stratification. Differentiation between subarachnoid space contrast leak and haemorrhage was also highlighted in this case series.

Conclusion Dual-energy CT head imaging emerges as a valuable adjunct in the post-MT evaluation of acute ischemic stroke patients. Its integration into routine clinical practice holds promise for enhancing diagnostic accuracy and guiding therapeutic planning, thereby improving patient outcome by ensuring the right anti-platelet/anti-coagulant strategy is deployed.

Disclosure of Interest no.