Presenter of 2 Presentations
CT ANGIOGRAPHIC IMAGING PATTERNS DIFFERENTIATE PSEUDO AND TRUE OCCLUSION OF THE PROXIMAL INTERNAL CAROTID ARTERY IN ACUTE ISCHEMIC STROKE
CT ANGIOGRAPHIC IMAGING PATTERNS DIFFERENTIATE PSEUDO AND TRUE OCCLUSION OF THE PROXIMAL INTERNAL CAROTID ARTERY IN ACUTE ISCHEMIC STROKE
Abstract
Background and Aims
Identifying pseudoocclusion (PO) of the proximal internal carotid artery (ICA) from true distal ICA occlusion has implications on successful recanalization and outcome after endovascular thrombectomy (EVT) in acute ischemic stroke (AIS). The aim of this study was to identify the CT angiographic patterns in differentiating a true occlusion from PO and to analyze the rate of successful recanalization after EVT.
Methods
This was a retrospective cohort study of patients with AIS and proximal ICA occlusion who underwent mechanical thrombectomy from 2014 to 2021. The patterns of carotid occlusion in CT angiogram (beak, dome or flat pattern) were reviewed and correlated with Digital subtraction angiography (DSA) images and categorized into PO and true occlusion. The rate of successful recanalization in PO and true occlusion were analyzed
Results
Of the 24 patients 16 (66%) had proximal ICA PO and 8 (33%) had true occlusion in DSA. A beak pattern of the proximal ICA on CTA was significantly higher in the PO group (87.5% vs. 25%, p value = 0.005), and a flat pattern was significantly higher in the true occlusion group (50% vs. 12%, p value = 0.005). A gradual contrast decline of the proximal ICA on CTA images was seen only in the PO (85.7%, p value = 0.05). There was no significant difference in the rate of successful recanalization between PO and true occlusion (81.25% vs 62.5%, p= 0.362)
Conclusions
The imaging patterns of proximal ICA in CTA can differentiate PO from true occlusion. This can help in planning intervention strategies and prognostication