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Updated: Mar 25, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Prediction of Stent-Retriever Thrombectomy Outcomes by Dynamic Multidetector CT Angiography in Patients with Acute
K M Thierfelder1, W H Sommer2, B Ertl-Wagner2
1From the Institute for Clinical Radiology (K.M.T., W.H.S., B.E.-W., S.E.B., F.G.M., W.G.K., M.F.R.) kolja.thierfelder@med.uni-muenchen.de.
Insights
Shorter occlusion length on dynamic CT angiography predicts successful stent retriever thrombectomy in acute ischemic stroke patients. This imaging metric aids in selecting patients for endovascular therapy.
Area of Science:
- Neuroimaging
- Interventional Neurology
- Stroke Medicine
Background:
- Endovascular therapy selection is crucial for stroke treatment.
- Dynamic CT angiography (CTA) offers insights into cerebral blood flow and tissue perfusion.
- Predictive markers for thrombectomy success are actively sought.
Purpose of the Study:
- To evaluate dynamic CTA parameters for predicting stent retriever thrombectomy outcomes.
- To assess occlusion length, collateralization, and time to enhancement as predictors.
- To identify key imaging markers for successful recanalization in acute ischemic stroke.
Main Methods:
- Retrospective analysis of 2059 acute ischemic stroke patients.
- Inclusion of patients with M1 MCA or carotid T occlusion undergoing thrombectomy.
- Dynamic CTA reconstructed from CT perfusion data; outcomes assessed by modified TICI and Rankin scales.
Main Results:
- A short occlusion length was an independent predictor of favorable angiographic outcome (mTICI=3).
- Collateralization and time to peak enhancement did not predict angiographic success.
- No dynamic CTA parameters predicted favorable clinical outcomes at discharge or 90 days.
Conclusions:
- Short occlusion length on dynamic CTA is a significant predictor of successful thrombectomy.
- Dynamic CTA can aid in patient selection for endovascular stroke treatment.
- Further research may explore combined imaging markers for improved outcome prediction.
Background And Purpose:
The selection of patients for endovascular therapy is an important issue in stroke imaging. The aim of this study was to determine the predictive value of 3 different dynamic CT angiography parameters, occlusion length, collateralization extent, and time delay to maximum enhancement, for latest generation of stent retriever thrombectomy recanalization outcomes in patients with acute ischemic stroke.
Materials And Methods:
In this study, subjects were selected from an initial cohort of 2059 consecutive patients who had undergone multiparametric CT, including whole-brain CT perfusion. We included all patients with a complete occlusion of the M1 segment of the MCA or the carotid T and subsequent intra-arterial stent retriever thrombectomy. Dynamic CT angiography was reconstructed from whole-brain CT perfusion raw datasets. Angiographic outcome was scored by using the modified TICI scale; and clinical outcome, by using the modified Rankin Scale. Logistic regression analyses were performed to determine independent predictors of a favorable angiographic (mTICI = 3) and clinical outcome (mRS ≤2).
Results:
Sixty-nine patients (mean age, 68 ± 14 years; 46% men) were included for statistical analysis. In the regression analysis, a short occlusion length was an independent predictor of favorable angiographic outcome (OR, 0.41; P < .05). Both collateralization grade (OR, 1.00; P > .05) and time delay to peak enhancement (OR, 0.90; P > .05) failed to predict a favorable angiographic outcome. None of the dynamic CT angiography predictors were significantly associated with clinical outcome on discharge (OR, 0.664-1.011; P = .330-.953) or at 90 days (OR, 0.779-1.016; P = .130-.845).
Conclusions:
A short occlusion length as determined by dynamic CT angiography is an independent predictor of a favorable angiographic outcome of stent retriever thrombectomy in patients with ischemic stroke.
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