Visualization of Distal Vessels during Mechanical Thrombectomy using Aortic Cone-beam Computed Tomography

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Mechanical thrombectomy for acute ischemic stroke requires clear visualization of distal vessels.
• Limited visibility beyond occlusion sites can lead to complications like vessel perforation.
• Conventional imaging techniques (MRI, DSA) often provide insufficient detail of distal intracranial vasculature.

Purpose of the Study:

• To evaluate the efficacy of aortic cone-beam computed tomography (aortic CBCT) in visualizing distal vessels beyond occlusion during mechanical thrombectomy.
• To compare the visualization capabilities of aortic CBCT against conventional imaging modalities.

Main Methods:

• Retrospective cohort study of 100 patients undergoing mechanical thrombectomy (2020-2024).
• Vessel visibility scored on a 5-point scale (1=excellent, 5=poor) for aortic CBCT, digital subtraction angiography (DSA), and magnetic resonance imaging (MRI).
• Statistical comparison using the Wilcoxon signed-rank test.

Main Results:

• Aortic CBCT achieved a median visibility score of 2.
• This score was significantly better than DSA (median 3, p < 0.001) and MRI (median 5, p < 0.001).
• Aortic CBCT demonstrated superior visualization of vessels distal to the occlusion site.

Conclusions:

• Aortic cone-beam computed tomography offers superior visualization of distal intracranial vessels compared to MRI and DSA.
• Improved visualization can enhance procedural safety during mechanical thrombectomy for stroke.
• Aortic CBCT is a valuable tool for navigating complex vascular anatomy in stroke intervention.