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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
09:21

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

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Dual-energy CT immediately after endovascular stroke intervention: prognostic implications

D Morhard1, L Ertl, W Gerdsmeier-Petz

  • 1Institute of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Klinikum Muenchen-Harlaching, Sanatoriumsplatz 2, 81545, Munich, Germany, morhard@nrad.de.

Cardiovascular and Interventional Radiology
|December 7, 2013
PubMed

Insights

Dual-energy CT reliably distinguishes blood-brain barrier disruption (BBBD) from intracerebral hemorrhage (ICH) after stroke recanalization therapy. BBBD is common, while ICH is rare, aiding immediate post-treatment assessment.

Area of Science:

  • Neuroradiology
  • Cerebrovascular Diseases
  • Medical Imaging

Background:

  • Intracerebral hemorrhage (ICH) following acute ischemic stroke recanalization therapy significantly increases patient morbidity and mortality.
  • Accurate and timely differentiation between ICH and blood-brain barrier disruption (BBBD) is crucial for patient management.

Purpose of the Study:

  • To evaluate the incidence of ICH and BBBD immediately after endovascular recanalization therapy for acute ischemic stroke.
  • To assess the correlation between postinterventional BBBD and final infarct or ICH size.
  • To determine the prognostic value of postinterventional BBBD.

Main Methods:

  • Retrospective analysis of imaging data from 60 patients undergoing endovascular recanalization for acute ischemic stroke.
  • Utilized pretreatment CT, posttreatment dual-energy CT (DE-CT), and follow-up imaging (CT/MRI).
  • Applied material differentiation on DE-CT to identify and differentiate hyperattenuating areas, correlating them with follow-up findings.

Main Results:

  • Hyperattenuation was observed in 80% of posttreatment CT scans.
  • ICH was confirmed in 10.4% of these cases, while 89.6% represented BBBD.
  • DE-CT demonstrated high accuracy for ICH detection (no false positives/negatives) and identified BBBD as a frequent finding.
  • No significant correlation was found between the extent of BBBD and final infarct or early ICH size.

Conclusions:

  • Blood-brain barrier disruption (BBBD) is a common occurrence following endovascular revascularization therapy for acute ischemic stroke.
  • Dual-energy CT provides reliable differentiation between frequent BBBD and rare ICH immediately after recanalization procedures.
  • DE-CT enhances immediate post-treatment assessment in stroke patients.
Abstract

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