Allison E. Arch, MD

Yang P, Niu K, Wu Y, Struffert T, Dorfler A, Schafer S, et al. Time-Resolved C-Arm Computed Tomographic Angiography Derived From Computed Tomographic Perfusion Acquisition: New Capability for One-Stop-Shop Acute Ischemic Stroke Treatment in the Angiosuite. Stroke. 2015

Outcomes are typically poor for patients with acute large vessel occlusions and ischemic stroke. Rapid endovascular recanalization is currently the best chance for meaningful neurologic recovery. Getting these patients into the endovascular suite quickly is a top priority. To minimize the delay that often occurs in the ED, a one-stop-shop has been proposed by Yang and colleagues, in which multimodal diagnostic imaging followed by endovascular clot retrieval would both occur in the same suite. To do this, the authors evaluated a non-enhanced C-arm cone beam CT system to obtain a non-enhanced cone beam CT, time-resolved CTA, and CT perfusion. They acquired dynamic perfusion parameters instead of using a steady state technique, and they used novel image processing algorithms. They hypothesized that if the image quality and diagnostic value of these reconstructed images were accurate, then patients may have a rapid one-stop-shop option for stroke treatment.
Twenty-one patients were included in the study, and 20 of them had successful reconstructed images. Two independent physicians interpreted the images, and they reached excellent agreement in making a diagnosis of large vessel occlusion using time-resolved C-arm cone beam CTA. The images were high quality with accurate detection of large vessel occlusions – both in the anterior and posterior circulations. The authors concluded that, “full head, subtracted, volume rendered, time-resolved C-arm cone beam CTAs can be reconstructed from C-arm cone beam CT dynamic perfusion measurements acquired in the angiography suite at the time of diagnostic or therapeutic interventions.”

Does this mean that patients with suspected large vessel occlusions will soon skip the ED and head directly into angiography suites? Only time will tell.