Clinical Study of Computed Tomography Angiography for Acute Cerebral Infarction

By Juan Wu¹, Jinyan Chen², Di Ji¹

Affiliations

1. Department of Imaging, The 904th Hospital of Joint Logistic Support Force (The 101st Hospital of PLA), Wuxi, China
2. Department of Central Disinfection Supply Room, The 904th Hospital of Joint Logistic Support Force (The 101st Hospital of PLA), Wuxi, China

doi: 10.29271/jcpsp.2025.07.935

Sir,

Acute cerebral infarction (ACI) represents a form of acute cerebrovascular disease characterised by a clinical syndrome resulting from cerebral vascular occlusion due to various aetiologies.¹ Previous research has indicated that, although thrombectomy is associated with a higher recurrence rate, patient prognoses can vary significantly.² This study aimed to investigate the relationship between collateral circulation (CC), as evaluated by the CT angiography, and the clinical outcomes of ACI patients following thrombectomy. Additionally, it was sought to assess the clinical significance of CC evaluation in the management of cerebral infarction patients beyond the therapeutic window. This retrospective, single-centre study was conducted from January 2019 to 2022. Out of the 220 screened ACI patients, 185 were initially included in the study.

Figure 1: The patient’s sudden left limb movement disturbance score for two hours (NIHSS) was 5. (A) Admitted CT showed no obvious low-density lesion in the right cerebral hemisphere, ASPECTS score was 9. (B) Preoperative CT showed right middle cerebral artery (MCA) M1 segment occlusion with good CC. (C) Intraoperative DSA showed occlusion segment. (D) DSA showed good vascular recanalisation after EVT. (E) Postoperative CT showed no contrast media extravasation and no brain swelling. (F) Seventy-two hours after EVT, MR showed a few infarcts in basal ganglia, and then the patient had no neurological dysfunction, with 0 score mRS.

Participants were categorised into either the good CC group or the poor CC group based on their CTA-MIP assessment scores. Specifically, patients with scores ranging from 2 to 4 were classified into the good CC group (n = 101), while those with scores below 2 were classified into the poor  CC group (n = 84).

Within the six-hour time window, the National Institutes of Health Stroke Scale (NIHSS) scores—preoperative, postoperative at 48 hours, and at discharge—were superior in the group with good CC compared to the group with poor circulation. Additionally, the modified Rankin Scale (mRS) score at discharge was more favourable in the good CC group. Similarly, in the 6-8 hour time window, the preoperative, postoperative at 48 hours, and at discharge, NIHSS scores as well as the mRS scores were better in the good CC group than in the poor circulation group. This investigation suggests that the individuals with good CC, as determined by computed tomography angiography (CTA), experienced more effective thrombectomy outcomes and improved postoperative neurological function during arterial thrombectomy. The mean length of hospitalisation was longer in the poor CC group compared to the good CC group. Furthermore, the average hospitalisation costs and complication rates were higher in the poor CC group. There was no significant difference in the rate of re-occlusion between the two groups (Figure 1).

ACI is one of the most prevalent cerebrovascular diseases, characterised by high rates of disability and mortality. Timely recanalisation of occluded blood vessels within the therapeutic time window can significantly enhance patient outcomes.^3-5 The findings of the current study indicate that within a six-hour time window, patients with favourable CC scores exhibited better outcomes compared to those with poor CC. Similarly, within the six to eight-hour time-window, the NIHSS scores were more favourable in the group with good CC compared to the group with poor CC.

COMPETING   INTEREST:
The  authors  declared  no  conflict  of  interest.

AUTHORS’   CONTRIBUTION:
JW: Wrote the first draft of the manuscript.
JC: Revised the manuscript, managed the project, and coordinated the study.
JW, JC, DJ: Collected and analysed the data.
JW, DJ: Contributed to conception and design of the study.
All authors approved the final version of the manuscript to be published.

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