Current Evidence on Periprocedural Flat-Panel CT in Endovascular Stroke Treatment: A Systematic Review and Meta-Analysis.

In 30 seconds

This systematic review and meta-analysis examined periprocedural flat-panel CT (FPCT) findings and clinical applications in patients undergoing endovascular stroke treatment. Across 40 studies and 4139 patients, intraparenchymal hyperattenuations were present in a pooled 49% (95% CI, 42%-56%) and were associated with intracranial hemorrhage and lower odds of good 90-day functional outcome (modified Rankin Scale score 0-2; odds ratio, 0.35 [95% CI, 0.24-0.50]). FPCT also showed potential for identifying residual occlusions and hypoperfusion. The authors note evidence of selection bias and call for prospective validation.

Key findings

• Intraparenchymal hyperattenuations occurred in 49% (95% CI, 42%-56%) and were associated with any intracranial hemorrhage (odds ratio, 10.4 [95% CI, 4.5-24.1]).
• Intraparenchymal hyperattenuations were associated with lower odds of good 90-day outcome (modified Rankin Scale score 0-2; odds ratio, 0.35 [95% CI, 0.24-0.50]).
• Subarachnoid hyperattenuations occurred in 23% (95% CI, 14%-35%) and were associated with lower odds of good 90-day outcome (odds ratio, 0.69 [95% CI, 0.53-0.91]).
• The distal occlusion tracker sign had 93% specificity (95% CI, 87%-96%) for residual distal occlusions after endovascular treatment.

Why it matters

FPCT can provide parenchymal and vascular information in the angiography suite, potentially helping identify hemorrhagic findings, residual occlusions, and hypoperfusion during or after endovascular treatment. The reported associations with functional outcomes make these imaging signs clinically relevant, but they do not establish that FPCT-guided decisions improve outcomes.

What to keep in mind

The evidence was drawn from observational studies and showed evidence of selection bias, with possible slight overreporting of imaging signs. The authors state that prospective validation is needed.