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Thoraco-Cervical Computed Tomographic Angiography to Determine an Appropriate Access Route for Mechanical

Toshimitsu Shimizu1, Takahisa Mori2, Kazuhiro Yoshioka2

  • 1Department of Radiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.

Journal of Neuroendovascular Therapy
|July 28, 2023
PubMed

Insights

Thoraco-cervical CTA is valuable for selecting access routes for mechanical thrombectomy. This imaging technique achieved a 100% successful insertion rate and short puncture-to-initial angiography times in acute stroke patients.

Area of Science:

  • Neurology
  • Vascular Imaging
  • Interventional Radiology

Background:

  • Mechanical thrombectomy (MT) is a critical treatment for acute ischemic stroke caused by large artery occlusion.
  • Determining the optimal access route (AR) is crucial for successful MT.
  • Thoraco-cervical computed tomography angiography (CTA) may offer valuable pre-procedural information.

Purpose of the Study:

  • To evaluate the utility of thoraco-cervical CTA in guiding the selection of an appropriate access route for mechanical thrombectomy.
  • To assess the impact of CTA-guided AR selection on procedural efficiency and success rates.

Main Methods:

  • Retrospective analysis of 32 acute stroke patients undergoing MT for anterior circulation large artery occlusion within 24 hours.
  • Evaluation of thoraco-cervical CTA findings including aortic arch type and take-off angles (TOA).
  • Comparison of procedural outcomes between femoral (F) and brachial (B) artery access groups, including successful insertion rate (SIR), puncture-to-initial angiography time (PtIA), and puncture-to-reperfusion time (PtR).

Main Results:

  • No significant differences in aortic arch types were observed between femoral and brachial access groups.
  • Proximal left common carotid artery (CCA) occlusions and take-off angles (TOA) < 25° were noted in two patients in the brachial access group.
  • Both groups achieved a 100% successful insertion rate (SIR), with median PtIA of 9.0 minutes (F) and 9.6 minutes (B), and median PtR of 54 minutes (F) and 72 minutes (B).

Conclusions:

  • Thoraco-cervical CTA provides essential information for selecting the optimal access route for mechanical thrombectomy.
  • The use of CTA facilitates high successful insertion rates and efficient procedures, as evidenced by short puncture-to-initial angiography times.
Abstract

Keywords:
access routecomputed tomographic angiographymechanical thrombectomy

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