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Updated: Mar 29, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Comparison of Imaging Selection Criteria for Intra-Arterial Thrombectomy in Acute Ischemic Stroke with Advanced CT
Eung Yeop Kim1, Dong Hoon Shin2, Young Noh2
1Department of Radiology, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea. neuroradkim@gmail.com.
Insights
Noncontrast CT with multi-phase CT angiography and CT perfusion are comparable for selecting patients for thrombectomy. Multi-phase CTA is more accurate than single-phase CTA for assessing collateral circulation.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Mechanical thrombectomy is a crucial treatment for acute ischemic stroke.
- Accurate patient selection is vital for successful thrombectomy outcomes.
- Noncontrast CT with multi-phase CT angiography (NCCT-MPCTA) and CT perfusion (CTP) are imaging modalities used for patient selection.
Purpose of the Study:
- To compare the efficacy of NCCT-MPCTA and CTP in determining eligibility for thrombectomy.
- To evaluate the accuracy of single-phase CTA (SPCTA) versus simulated MPCTA in assessing collateral circulation.
Main Methods:
- Retrospective analysis of 71 patients who underwent NCCT, CTP, and SPCTA within 6 hours of stroke onset.
- Simulated MPCTA reconstructed from CTP images for collateral assessment.
- Eligibility criteria included infarct core/penumbra mismatch (CTP-A, CTP-B) and ASPECTS with collaterals (NCCT-MPCTA).
Main Results:
- CTP-B identified 11 ineligible patients; 3 were eligible by NCCT-MPCTA and 6 by CTP-A.
- No significant statistical difference in thrombectomy eligibility determination between NCCT-MPCTA and CTP (P > 0.05).
- SPCTA showed significantly more poor collaterals (n=22) compared to MPCTA (n=6; P < 0.0001).
Conclusions:
- NCCT-MPCTA and CTP are statistically comparable for selecting patients eligible for thrombectomy.
- Multi-phase CTA is superior to single-phase CTA for evaluating collateral status.
- Both imaging techniques aid in optimizing patient selection for mechanical thrombectomy.
Objectives:
To compare two selection criteria (noncontrast CT [NCCT] with multi-phase CT Angiography [MPCTA] and CT perfusion [CTP]) for the determination of eligibility for thrombectomy.
Methods:
We retrospectively enrolled 71 patients who underwent head NCCT, 9.6-cm CTP, and craniocervical single-phase CTA (SPCTA) within 6 hours of onset. The simulated MPCTA was reconstructed from 1-mm CTP images for assessment of collateral circulation. Infarct core (relative CBF < 30 %) and penumbra (Tmax > 6 seconds) volumes were measured. The infarct core < 70 mL with a mismatch ratio > 1.2 (CTP-A), infarct core ≤ 40 mL with a mismatch ratio > 1.8 (CTP-B), and ASPECTS > 5 with good collaterals (50 % ≥ MCA territory) were used to determine eligibility for thrombectomy. SPCTA was compared with the simulated MPCTA for assessment of collaterals.
Results:
CTP-B determined that 11 patients were ineligible for thrombectomy, of which three were eligible by NCCT with MPCTA and 6 by CTP-A. CTP-A and CTP-B showed discrepancy in determining eligibility for thrombectomy between NCCT with MPCTA in three patients each, rendering no significant statistical difference (P > 0.05). The number of patients with poor collaterals was significantly higher on SPCTA than MPCTA (n = 22 and 6 respectively; P < 0.0001).
Conclusion:
The two imaging selection criteria (NCCT with MPCTA and CTP) were statistically comparable for determining eligibility for thrombectomy.
Key Points:
• Early mechanical thrombectomy improves clinical outcomes. • Noncontrast CT-multi-phase CTA is used for determining eligibility for thrombectomy. • CTP can help to select patients who are eligible for thrombectomy. • Noncontrast CT-multi-phase CTA and CTP are comparable for patient selection. • Multi-phase CTA is more accurate than single-phase CTA for assessment of collaterals.
