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17.02.2017 | Interventional

Influence of a combined CT/C-arm system on periprocedural workflow and procedure times in mechanical thrombectomy

verfasst von: Johannes Pfaff, Silvia Schönenberger, Christian Herweh, Mirko Pham, Simon Nagel, Peter Arthur Ringleb, Sabine Heiland, Martin Bendszus, Markus Alfred Möhlenbruch

Erschienen in: European Radiology | Ausgabe 9/2017

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Abstract

Objective

To achieve the fastest possible workflow in ischaemic stroke, we developed a CT/C-arm system, which allows imaging and endovascular treatment on the same patient table.

Methods

This prospective, monocentric trial was conducted between October 2014 and August 2016. Patients received stroke imaging and mechanical thrombectomy under general anaesthesia (GA) or conscious sedation (CS) using our combined setup comprising a CT-scanner and a mobile C-arm X-ray device. Primary endpoint was time between stroke imaging and groin puncture. We compared periprocedural workflow and procedure times with the literature and a matched patient cohort treated with a biplane angiographic system before installation of the CT/C-arm system.

Results

In 50 patients with acute ischaemic stroke due to large-vessel occlusion in the anterior circulation, comparable recanalization rates were achieved by using the CT/C-arm setup (TICI2b-3:CT/C-arm-GA: 85.7%; CT/C-arm-CS: 90.9%; Angiosuite: 78.6%; p = 0.269) without increasing periprocedural complications. Elimination of patient transport resulted in a significant reduction of the time between stroke imaging and groin puncture: median, min (IQR): CT/C-arm-GA: 43 (35–52); CT/C-arm-CS: 39 (28–49); Angiosuite: 64 (48–74); p < 0.0001.

Conclusion

The combined CT/C-arm system allows comparable recanalization rates as a biplane angiographic system and accelerates the start of the endovascular stroke treatment.

Key Points

• The CT/C-arm setup reduces median time from stroke imaging to groin puncture.

• Mechanical thrombectomy using a C-arm device is feasible without increasing peri-interventional complications.

• The CT/C-arm setup might be a valuable fallback solution for emergency procedures.

• The CT/C-arm setup allows immediate control CT images during and after treatment.

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Titel: Influence of a combined CT/C-arm system on periprocedural workflow and procedure times in mechanical thrombectomy
verfasst von: Johannes Pfaff
Silvia Schönenberger
Christian Herweh
Mirko Pham
Simon Nagel
Peter Arthur Ringleb
Sabine Heiland
Martin Bendszus
Markus Alfred Möhlenbruch
Publikationsdatum: 17.02.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 9/2017
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-017-4762-7

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Influence of a combined CT/C-arm system on periprocedural workflow and procedure times in mechanical thrombectomy