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

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.