Abstract WP59: Intraoperative Cbv Measurement for the Treatment of Ischemic Stroke

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Introduction: Prediction of ischemic core during the thrombectomy procedure can contribute to the treatment strategy. To evaluate if the Cone Beam CT CBV (CBCT-CBV) can predict the image findings of post procedure MRI, retrospective analysis was performed.Methods: A total of 14 ischemic stroke cases with major vessel occlusion underwent CBCT-CBV. A 4 French diagnostic catheter, which was placed in the guiding catheter, was positioned at the ascending aorta. Utilizing 6 seconds acquisition (6Sec Dyna PBV Neuro, Siemens Healthcare), 30% diluted contrast was injected with the speed of 6ml/sec. The reconstruction of the images with CBV color mapping was created immediately after the acquisition. The pre and post procedure CBCT-CBV data was compared with the corresponding MRI images and the results were retrospectively analyzed.Results: Of the 14 cases who showed major vessel occlusion, 6 underwent both pre and post CBCT-CBV. Location of the occluded vessels were internal carotid artery (ICA) (4 cases), middle cerebral artery (9 cases) and 1 basilar artery. No case showed increased CBV. Five cases showed a significant reduction of regional CBV (mean reduction; 72.65%) at the end of the procedure. All these cases showed DWI high regions in the post procedure MRI matched with the area of CBCT-CBV reduction (100%). Of the 6 cases who underwent both pre and post procedure CBCT-CBV, 3 showed decreased CBV in the pre-procedure CBV. After the recanalization of the occluded vessels, the regional CBV was normalized to the level of contra lateral side in every case.Conclusions: Intra-operative CBCT-CBV showed recovery of the reduced CBV after the recanalization in some cases. The area of reduced CBV at the end of procedure was matched with the DWI positive region in the post-procedure MRI (100%). Intra-operative CBCT-CBV may contribute to the prediction of post-operative ischemic core.

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