Semi-automated mapping of occluded arterial segments in acute large vessel stroke from computed tomography
Santhosh Kumar Kannath1, Ajimimol Anzar2, Jithin Sivan Sulaja3
1Additional Professor, Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute For Medical Sciences And Technology, Trivandrum, Kerala, India.
Insights
Reconstructing occluded arteries from CT angiography is feasible for guiding mechanical thrombectomy. This method accurately maps intracranial artery anatomy, improving procedural safety and efficiency.
Area of Science:
- Neurology
- Medical Imaging
- Interventional Radiology
Background:
- Mechanical thrombectomy for large vessel occlusions requires precise catheterization of the occluded artery.
- This critical step is currently performed blindly, posing risks of adverse events.
- CT angiography (CTA) offers potential for pre-procedural vascular reconstruction.
Purpose of the Study:
- To evaluate the feasibility of reconstructing occluded intracranial arteries from CTA data.
- To assess the accuracy of this reconstruction in guiding mechanical thrombectomy.
- To determine the potential of CTA-based vascular mapping in improving thrombectomy procedures.
Main Methods:
- Semi-automated 3D segmentation software was used to reconstruct arterial anatomy from CTA in 25 patients.
- Reconstructions were compared against post-thrombectomy angiograms for congruence of major arterial segments.
- Two independent observers performed the reconstructions, and interrater agreement was assessed.
Main Results:
- Accurate arterial mapping was achieved in 88% (observer 1) and 92% (observer 2) of patients.
- Mild mismatches occurred in two patients, primarily in the superior division.
- Reconstruction time was a median of 4 minutes, with good interrater agreement (0.77).
Conclusions:
- Delineation of major intracranial artery anatomy from CTA is feasible and accurate.
- This technique corresponds well with the actual vascular anatomy.
- CTA-based vascular reconstruction can serve as a valuable guide during thrombectomy procedures.
Objectives:
Catheterisation of occluded artery is the most crucial step in the mechanical thrombectomy of large vessel occlusions. Being a blind procedure, potential major untoward events could be anticipated at this stage. In this study, we evaluated the feasibility of reconstruction of the occluded vascular segment from CT angiography, exploiting the attenuation difference between the clot and adjacent brain parenchyma.
Methods And Results:
Twenty-five patients with large vessel occlusion who achieved TICI2B/3 recanalization were identified. The semi-automated reconstruction was done using an open-source 3D segmentation software by two observers. The generated arterial anatomy was categorized as congruent, if all the major arterial segments namely, internal carotid artery, M1 middle cerebral artery, bifurcation, and major divisions matched with post thrombectomy angiograms. The discrepancy of one or more than one arterial segment was classified as mild or total mismatch respectively. Congruent arterial mapping was possible in 88% and 92 % patients for observer 1 and observer 2 respectively, while mild mismatch was noted in two patients for both the observers. Mismatch mostly occurred in superior division for both observers(100% vs 66.6%). The interrater agreement was good (0.77) and the accuracy was not influenced by the length of the clot. The median time for reconstruction was 4 minutes for both the observers (p - 0.21).
Conclusion:
Delineation of the anatomy of the occluded major intracranial artery is possible and corresponds with the actual anatomy. It could be used as a guide during thrombectomy procedures.
