Acute Ischemic Stroke and CT Cerebral Angiography: Management and Relationship View PDF

^*Khalid Faiq Abood Al-Khalidy
Basrah Health Directorate, Ministry Of Health / Environment, Al-Sadder Teaching Hospital, Basrah, Iraq

^*Corresponding Author:

Khalid Faiq Abood Al-Khalidy
Basrah Health Directorate, Ministry Of Health / Environment, Al-Sadder Teaching Hospital, Basrah, Iraq
Email:Medicalresearch82@yahoo.com

Published on: 2022-04-04

Abstract

In general, stroke is the second leading cause of mortality and a leading cause of morbidity. The most common type is thrombotic which responsible for 65-85%. Treatments that are approved by guidelines include supportive care in an emergency unit, and reperfusion through use of intravenous recombinant-tissue plasminogen activator (r-tPA), intra-arterial fibrinolysis and mechanical thrombectomy. A prospective study carried out in two years enrolled patients with acute ischemic stroke who have done CT angiography of cerebral circulation to assessment of the collateral arterial state. A total number of 50 patients (25 males and 25 females). The main age was 53.7±11.56 years. Each patient was neurologically and clinically evaluated, underwent NCCT followed by CT cerebral angiography to assess large vessel occlusion, collateral circulation status according to Tan scale (0-3). Good state of the cerebral collaterals in patients with AIS was associated with good clinical outcome, good reperfusion, symptomatic ICH rate is low, mortality rate decline and stroke severity be less.

Keywords

Angiography, Acute Ischemic Stroke, Recombinant-Tissue Plasminogen Activator, Mechanical Thrombectomy

Introduction

Ischemic stroke is the leading cause of disabling disease and mortality worldwide [1]. Rapid evaluation including clinical examination and radiological investigations of patients with suspected AIS are mandatory to confirm detection, exclude common stroke mimics, determine the contraindications to revascularization, and localised site of occlusion [2]. Management decision (IV thrombolysis and/or mechanical revascularization) is dependent on the time window and imaging sings: parenchymal lesion and arterial occlusion site [3]. Multimodal CT includes CTA of head and neck, CT perfusion (CTP), multimodal MRI includes various sequences, such as DWI, ADC, FLAIR, GRE, and perfusion-weighted imaging in addition to MRA of head and neck help making a decision of acute management [4,5]. CTA is used to localised the site of vascular occlusion and quality of the collateral flow, which is an important prognostic factor for good outcome of management [6]. CTA can display collateral supply at the level of Willis’ circle arteries and the retrograde filling of the cortical arteries by leptomeningeal junctions. The development of arterial collaterals lowers the speed of infarction growth and increases the chance of a good clinical outcome with timely recanalization [7].

The reperfusion treatment including intravenous (r-tPA) and mechanical thrombectomy are approved, so this study aimed to evaluate the relation of collateral status in CTA to the clinical outcome of AIS management.