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*Only for medical professionals to read for reference.
The application of multi-mode CT in endovascular treatment of acute ischemic stroke + detailed case explanation.
Stroke is the first cause of death and disability among Chinese residents.
Emergency recanalization is an effective method for the treatment of stroke It is especially important in cerebral infarction due to occlusion of large arteries, and its usual significance includes vascular venous thrombolysis and interventional therapy
.
So, which method to choose for vascular recanalization is exactly what reflects the level of a neurologist.
Among them, the use of imaging evaluation is our advantageous weapon
.
This article will introduce the application experience of multi-modal CT in the emergency endovascular treatment of stroke by Professor Hongbing Chen from the First Affiliated Hospital of Sun Yat-sen University, in order to jointly improve the clinical level
.
Figure 1: The ultimate goal of the development and progress of imaging technology.
CT is the first choice for stroke emergency imaging.
Multi-modal CT usually refers to CT plain scan + CTA + CTP
.
Advantages: easy to obtain, multi-slice spiral CT is commonly equipped in hospitals at all levels, and the scanning is fast and convenient.
It is especially important for strokes where time is the brain.
The interpretation is consistent and meets the needs of different levels
.
Figure 2: As shown on the left, a scan clearly shows the structure of the brain, the condition of the large blood vessels in the brain, and the blood perfusion.
The content of the multi-mode CT evaluation is the condition of the lumen and the wall, which is processed by computer software.
The method is quantitatively measured
.
The goal is to provide a reference for our clinical decision-making, based on objective data, but relying too much on personal experience to obtain higher repeatability and consistency
.
CT plain scan firstly helps us to rule out non-cerebral infarction conditions, such as cerebral hemorrhage, tumors, etc.
, and can provide early signs of cerebral infarction and show signs of high density of thrombus, for ASPECT score
.
Figure 3 Figure 4 Figure 5 Figure 3-5: Examples of early CT manifestations of cerebral infarction.
CT plain scan can also show cerebral arterial hyperdensity.
The arterial density mainly depends on the hemoglobin concentration, usually close to the cerebral cortex density.
When the red thrombus occludes the artery At this time, the density of the occluded artery in this segment was significantly higher than that of the adjacent unoccluded artery and cortex
.
The CT scan showed a high density of cords or small nodules, with clear and sharp borders
.
Arterial hyperdensity sign is a strong prompt for thrombus removal, whether it is a progressive stroke or atherosclerosis! Figure 6 Figure 7 Figure 8 Figure 6-8: Cerebral Artery High Density Signs CT plain scan + CTA through computer post-reconstruction technology, can show the occluded segment of blood vessels + the nature of vascular disease
.
Figure 9: The occlusion is relatively limited and proximal, and there is no high-density sign on thin-section CT.
Considering the occlusion caused by atherosclerosis, it is not necessary to remove the thrombus.
Figure 10: The proximal middle cerebral artery occlusion, visible High-density sign, combined with a history of atrial fibrillation, consider thromboembolism, and be treated with thrombus removal.
Figure 11: Calcified emboli, preoperative CT value 200+, postoperative review C, stent pushes calcified substances to one side, red arrow Figure 12: The red arrow is thrombus, the yellow arrow is calcification, and the orange arrow is plaque.
Figure 13: The left carotid artery on the upper right CT is obviously thickened compared to the right, red arrow
.
MRI confirms dissection in the lower right image, yellow arrow Figure 14: Chronic occlusion of the carotid artery, the middle image CT yellow arrow low-density plaque, the distal lumen is collapsed, the red arrow indicates the derivative artery, the right image is still MRI Prompt chronic occlusion, no thrombus is seen.
Figure 15: Carotid artery occlusion.
The orange arrow indicates that there is no plaque in the extracranial segment.
The outline of the blood vessel is thick and full of low-density shadows.
The orange arrow in the intracranial segment indicates that the most important role of calcification CTPCTP is to assess whether There is an ischemic penumbra, which predicts the effect after opening the blood vessel
.
Comprehensively judge the size of core infarct area and ischemic penumbra through CBF, CBV and TTP
.
Actual Combat Analysis▌ The patient had a stroke after waking up, onset for more than 6 hours, a 64-year-old female, with a score of 12 on the National Institutes of Health Stroke Scale (NIHSS), underlying diseases, rheumatic heart disease, and atrial fibrillation
.
Figure 16: Case 1 CT plain scan shows ASPECT high, CTA shows the occlusion of the distal middle cerebral artery on the right side, the path is better, the red arrow in the lower left corner indicates the arterial hyperdensity sign, suggesting thrombosis, TTP prolonged, CBV, CBF fair , Suggesting the presence of ischemic penumbra; interventional thrombectomy was performed to open blood vessels
.
▌ Case two, bridging surgery after thrombolysis, unexplained cerebral embolism; 4 hours after onset, 70-year-old male, NIHSS score 11; basic disease hypertension, coronary heart disease
.
Figure 17: Case 2 CTA showed stenosis of the middle cerebral artery-internal carotid artery, the right anterior cerebral artery was not visible, combined with CTP, the right anterior cerebral artery area has seen core infarction, and the middle cerebral artery area is still half ischemic.
Dark zone, tortuous neck blood vessels can be seen
.
CT plain scan shows the sign of arterial hyperdensity, CTA suggests filling defect, comprehensive judgment does not consider stenosis, in practice, the embolization is still intervened
.
▌ Case 3 Progressive stroke, middle cerebral artery atherosclerosis obliteration; 50-year-old male, onset for 5 days, progressing a little every day
.
Figure 18: In case 3, the balloon was used to expand the narrowed blood vessels, which significantly relieved the symptoms
.
▌ Case 4 Atherosclerotic occlusion of the basilar artery + massive thrombosis at the distal end
.
Figure 19: Case 4 has a basilar atherosclerotic occlusion with an onset of more than 48 hours, combined with a large number of distal thrombosis.
This type of patient progresses very quickly.
As the thrombosis at the distal end of the occlusion and spreads, the symptoms become more and more severe
.
After the patient was transferred to the hospital, CT scan revealed the high density of the basilar artery, the left pons was acceptable, the right pons was infarcted, and the apex of the basal artery was still visible.
The patient was still conscious
.
Interventional surgery was chosen.
After several operations, the embolus was finally removed and the stent was placed, which saved the patient
.
Summary The content of multi-mode CT evaluation is the condition of the lumen and the tube wall, which is quantitatively measured by the method of computer software processing
.
The goal is to provide a reference for our clinical decision-making, based on objective facts, but relying too much on personal experience to obtain higher repeatability and consistency
.
Figure 20: Summary of multi-mode CT clinical application Note: The views and pictures in this article are from the lecture given by Professor Hongbing Chen from the First Affiliated Hospital of Sun Yat-Sen University at the 24th National Neurology Conference of the Chinese Medical Association
.
The application of multi-mode CT in endovascular treatment of acute ischemic stroke + detailed case explanation.
Stroke is the first cause of death and disability among Chinese residents.
Emergency recanalization is an effective method for the treatment of stroke It is especially important in cerebral infarction due to occlusion of large arteries, and its usual significance includes vascular venous thrombolysis and interventional therapy
.
So, which method to choose for vascular recanalization is exactly what reflects the level of a neurologist.
Among them, the use of imaging evaluation is our advantageous weapon
.
This article will introduce the application experience of multi-modal CT in the emergency endovascular treatment of stroke by Professor Hongbing Chen from the First Affiliated Hospital of Sun Yat-sen University, in order to jointly improve the clinical level
.
Figure 1: The ultimate goal of the development and progress of imaging technology.
CT is the first choice for stroke emergency imaging.
Multi-modal CT usually refers to CT plain scan + CTA + CTP
.
Advantages: easy to obtain, multi-slice spiral CT is commonly equipped in hospitals at all levels, and the scanning is fast and convenient.
It is especially important for strokes where time is the brain.
The interpretation is consistent and meets the needs of different levels
.
Figure 2: As shown on the left, a scan clearly shows the structure of the brain, the condition of the large blood vessels in the brain, and the blood perfusion.
The content of the multi-mode CT evaluation is the condition of the lumen and the wall, which is processed by computer software.
The method is quantitatively measured
.
The goal is to provide a reference for our clinical decision-making, based on objective data, but relying too much on personal experience to obtain higher repeatability and consistency
.
CT plain scan firstly helps us to rule out non-cerebral infarction conditions, such as cerebral hemorrhage, tumors, etc.
, and can provide early signs of cerebral infarction and show signs of high density of thrombus, for ASPECT score
.
Figure 3 Figure 4 Figure 5 Figure 3-5: Examples of early CT manifestations of cerebral infarction.
CT plain scan can also show cerebral arterial hyperdensity.
The arterial density mainly depends on the hemoglobin concentration, usually close to the cerebral cortex density.
When the red thrombus occludes the artery At this time, the density of the occluded artery in this segment was significantly higher than that of the adjacent unoccluded artery and cortex
.
The CT scan showed a high density of cords or small nodules, with clear and sharp borders
.
Arterial hyperdensity sign is a strong prompt for thrombus removal, whether it is a progressive stroke or atherosclerosis! Figure 6 Figure 7 Figure 8 Figure 6-8: Cerebral Artery High Density Signs CT plain scan + CTA through computer post-reconstruction technology, can show the occluded segment of blood vessels + the nature of vascular disease
.
Figure 9: The occlusion is relatively limited and proximal, and there is no high-density sign on thin-section CT.
Considering the occlusion caused by atherosclerosis, it is not necessary to remove the thrombus.
Figure 10: The proximal middle cerebral artery occlusion, visible High-density sign, combined with a history of atrial fibrillation, consider thromboembolism, and be treated with thrombus removal.
Figure 11: Calcified emboli, preoperative CT value 200+, postoperative review C, stent pushes calcified substances to one side, red arrow Figure 12: The red arrow is thrombus, the yellow arrow is calcification, and the orange arrow is plaque.
Figure 13: The left carotid artery on the upper right CT is obviously thickened compared to the right, red arrow
.
MRI confirms dissection in the lower right image, yellow arrow Figure 14: Chronic occlusion of the carotid artery, the middle image CT yellow arrow low-density plaque, the distal lumen is collapsed, the red arrow indicates the derivative artery, the right image is still MRI Prompt chronic occlusion, no thrombus is seen.
Figure 15: Carotid artery occlusion.
The orange arrow indicates that there is no plaque in the extracranial segment.
The outline of the blood vessel is thick and full of low-density shadows.
The orange arrow in the intracranial segment indicates that the most important role of calcification CTPCTP is to assess whether There is an ischemic penumbra, which predicts the effect after opening the blood vessel
.
Comprehensively judge the size of core infarct area and ischemic penumbra through CBF, CBV and TTP
.
Actual Combat Analysis▌ The patient had a stroke after waking up, onset for more than 6 hours, a 64-year-old female, with a score of 12 on the National Institutes of Health Stroke Scale (NIHSS), underlying diseases, rheumatic heart disease, and atrial fibrillation
.
Figure 16: Case 1 CT plain scan shows ASPECT high, CTA shows the occlusion of the distal middle cerebral artery on the right side, the path is better, the red arrow in the lower left corner indicates the arterial hyperdensity sign, suggesting thrombosis, TTP prolonged, CBV, CBF fair , Suggesting the presence of ischemic penumbra; interventional thrombectomy was performed to open blood vessels
.
▌ Case two, bridging surgery after thrombolysis, unexplained cerebral embolism; 4 hours after onset, 70-year-old male, NIHSS score 11; basic disease hypertension, coronary heart disease
.
Figure 17: Case 2 CTA showed stenosis of the middle cerebral artery-internal carotid artery, the right anterior cerebral artery was not visible, combined with CTP, the right anterior cerebral artery area has seen core infarction, and the middle cerebral artery area is still half ischemic.
Dark zone, tortuous neck blood vessels can be seen
.
CT plain scan shows the sign of arterial hyperdensity, CTA suggests filling defect, comprehensive judgment does not consider stenosis, in practice, the embolization is still intervened
.
▌ Case 3 Progressive stroke, middle cerebral artery atherosclerosis obliteration; 50-year-old male, onset for 5 days, progressing a little every day
.
Figure 18: In case 3, the balloon was used to expand the narrowed blood vessels, which significantly relieved the symptoms
.
▌ Case 4 Atherosclerotic occlusion of the basilar artery + massive thrombosis at the distal end
.
Figure 19: Case 4 has a basilar atherosclerotic occlusion with an onset of more than 48 hours, combined with a large number of distal thrombosis.
This type of patient progresses very quickly.
As the thrombosis at the distal end of the occlusion and spreads, the symptoms become more and more severe
.
After the patient was transferred to the hospital, CT scan revealed the high density of the basilar artery, the left pons was acceptable, the right pons was infarcted, and the apex of the basal artery was still visible.
The patient was still conscious
.
Interventional surgery was chosen.
After several operations, the embolus was finally removed and the stent was placed, which saved the patient
.
Summary The content of multi-mode CT evaluation is the condition of the lumen and the tube wall, which is quantitatively measured by the method of computer software processing
.
The goal is to provide a reference for our clinical decision-making, based on objective facts, but relying too much on personal experience to obtain higher repeatability and consistency
.
Figure 20: Summary of multi-mode CT clinical application Note: The views and pictures in this article are from the lecture given by Professor Hongbing Chen from the First Affiliated Hospital of Sun Yat-Sen University at the 24th National Neurology Conference of the Chinese Medical Association
.
