Abstract Number ‐ 26: Results from Flat‐Panel CT as a predictor following Mechanical Thrombectomy

Introduction Flat‐panel CT provides quick and effective parenchymal cross‐sectional imaging. Pre‐thrombectomy, flat‐panel can be obtained to evaluate ischemic stroke patients for thrombectomy candidacy in cases where the traditional CT scanner is bypassed. Post‐thrombectomy images obtained from flat‐panel CT are also effective in evaluating complications such as contrast extravasation, hemorrhage, or increased core size. Findings on flat‐panel CT may provide information to guide decisions such as blood pressure goals, antiplatelet or anticoagulation regimen, thrombolytic reversal, and the need for emergent neurosurgical intervention in rare cases. Methods We analyzed 93 thrombectomy cases from 2021 to 2022, where flat‐panel CT was obtained, with follow‐up CT and MRI. Demographics were reviewed for this series of cases. Cases where stratified and compared depending on results on flat‐panel CT. Medical records were reviewed for changes in management. The local IRB approved the project, and consent was waived according to institutional guidelines. Results For our patient population, the median age was 70; race was 59% Caucasian, 40% African American, and 1% Hispanic; and gender was 46% female and 54% male. From the flat‐panel CT, we had the following results: Flat‐panel CT was normal in 68% of cases, 20% had contrast extravasation, 9% showed evidence of contrast extravasation vs. hemorrhage, 2% had hemorrhage during the procedure, and 1% had contrast retained in the vessels. On follow‐up CT, 35% had no change, 16% had contrast extravasation, 8% had SAH, 4% had contrast extravasation vs. hemorrhage, 3% had hemorrhagic transformation, 1% had IVH, 1% had petechial hemorrhages, and 31% had no follow‐up CT. On MRI, 20% had hemorrhagic transformation, 41% had no hemorrhage, 6% had microhemorrhages, 10% had petechial hemorrhages, 2% had ICH, 1% had 1 IVH, 1% had SAH, 1% had contrast extravasation, 17% of the cases had no follow‐up MRI. Based on flat‐panel CT, results for normal and contrast extravasation were as follows (Table 1.). Therapy was altered by the flat‐panel CT results in 10 cases. The main change in therapy was a delay in restarting antiplatelet and anticoagulation therapy, which took place in 9 cases. Conclusions Post thrombectomy flat‐panel CT is a useful screen post thrombectomy for high‐risk findings such as contrast extravasation and hemorrhagic transformation. Further studies are needed to determine ideal management in cases of contrast extravasation or hemorrhage on flat‐panel CT.