What is hyperdensity in the brain

Cone-beam computed tomography after thrombectomy

detailed description

By December 2014, intravenous thrombolysis was the only proven reperfusion therapy to be effective within 4 hours of a cerebral infarction, and several studies showed a clear functional benefit of thrombectomy in combination with thrombolysis in the first six hours of proximal arterial occlusion. Cerebral bleeding after reperfusion treatment includes not only breaking the blood-brain barrier, but also direct damage to vessels associated with the equipment used and secondary toxicity to thrombolytics. The rupture of the blood-brain barrier that results from ischemia / reperfusion is responsible for the stagnation of contrast agent in examinations performed after thrombectomy, but it is difficult to distinguish hyperdensities associated with stagnation of contrast agent and bleeding with a conventional scanner . Various techniques are available for assessing hyperdensities after endovascular cerebral reperfusion, including: dual energy ct, flat-screen CT performed in the angiography room, and conventional scanner. The Cone Beam CT is a relevant examination because it is performed in the angiography room and does not require transport of the patient who can be moved or intubated to the scanner. The reference imaging is the double energy scanner at the thrombectomy exit. Some studies have shown an excellent negative predictive value of flat panel CT for clearing bleeding during post-thrombectomy.No study has compared the results of the flat panel directly with those done in CT immediately after the thrombectomy, and even less with the dual energy scanner, making it difficult to say to recognize the sensitivity and exact specificity of this test and to distinguish bleeding from contrast stagnation. The investigators propose a direct comparison of the cone-beam CT with the dual-energy CT performed at the exit of the thrombectomy. Method: Consecutive patients with acute ischemic stroke candidates for thrombectomy will be enrolled in a hospital center. At the end of the procedure, a cone beam Ct is performed as well as a dual energy CT and finally a CT 24 h after the thrombectomy. Second, predictive factors for bleeding transformation such as a disruption of the blood barrier are examined.