Value of Immediate Flat Panel Perfusion Imaging after Endovascular Therapy (AFTERMATH): a Proof of Concept Study.

Mujanovic, Adnan; Kurmann, Christoph C.; Manhart, Michael; Piechowiak, Eike I.; Pilgram-Pastor, Sara M.; Serrallach, Bettina L.; Boulouis, Gregoire; Meinel, Thomas R.; Seiffge, David J.; Jung, Simon; Arnold, Marcel; Nguyen, Thanh N; Fischer, Urs; Gralla, Jan; Dobrocky, Tomas; Mordasini, Pasquale; Kaesmacher, Johannes (2024). Value of Immediate Flat Panel Perfusion Imaging after Endovascular Therapy (AFTERMATH): a Proof of Concept Study. AJNR. American journal of neuroradiology, 45(2), pp. 163-170. American Society of Neuroradiology 10.3174/ajnr.A8103

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BACKGROUND AND PURPOSE

Potential utility of flat panel CT perfusion imaging (FPCT-PI) performed immediately after mechanical thrombectomy (MT) is unknown. We aimed to assess whether FPCT-PI obtained directly post-MT could provide additional potentially relevant information on tissue reperfusion status.

MATERIALS AND METHODS

This was a single-center analysis of all patients with consecutive acute stroke admitted between June 2019 and March 2021 who underwent MT and postinterventional FPCT-PI (n = 26). A core lab blinded to technical details and clinical data performed TICI grading on postinterventional DSA images and qualitatively assessed reperfusion on time-sensitive FPCT-PI maps. According to agreement between DSA and FPCT-PI, all patients were classified into 4 groups: hypoperfusion findings perfectly matched by location (group 1), hypoperfusion findings mismatched by location (group 2), complete reperfusion on DSA with hypoperfusion on FPCT-PI (group 3), and hypoperfusion on DSA with complete reperfusion on FPCT-PI (group 4).

RESULTS

Detection of hypoperfusion (present/absent) concurred in 21/26 patients. Of these, reperfusion findings showed perfect agreement on location and size in 16 patients (group 1), while in 5 patients there was a mismatch by location (group 2). Of the remaining 5 patients with disagreement regarding the presence or absence of hypoperfusion, 3 were classified into group 3 and 2 into group 4. FPCT-PI findings could have avoided TICI overestimation in all false-positive operator-rated TICI 3 cases (10/26).

CONCLUSIONS

FPCT-PI may provide additional clinically relevant information in a considerable proportion of patients undergoing MT. Hence, FPCT-PI may complement the evaluation of reperfusion efficacy and potentially inform decision-making in the angiography suite.

Item Type:

 Journal Article (Original Article)

Division/Institute:

 04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology

Graduate School:

 Graduate School for Health Sciences (GHS)

UniBE Contributor:

 Kurmann, Christoph Carmelino, Piechowiak, Eike Immo, Pilgram-Pastor, Sara Magdalena, Serrallach, Bettina Lara, Meinel, Thomas Raphael, Seiffge, David Julian, Jung, Simon, Arnold, Marcel, Fischer, Urs Martin, Gralla, Jan, Dobrocky, Tomas, Mordasini, Pasquale Ranato, Kaesmacher, Johannes

Subjects:

 600 Technology > 610 Medicine & health

ISSN:

 1936-959X

Publisher:

 American Society of Neuroradiology

Language:

 English

Submitter:

 Pubmed Import

Date Deposited:

 19 Jan 2024 11:59

Last Modified:

 09 Feb 2024 00:16

Publisher DOI:

 10.3174/ajnr.A8103

PubMed ID:

 38238089

BORIS DOI:

 10.48350/191794

URI:

 https://boris.unibe.ch/id/eprint/191794

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