Visualization of Distal Vessels during Mechanical Thrombectomy using Aortic Cone-beam Computed Tomography

During mechanical thrombectomy, manipulation under the limited visibility of vessels distal to the occlusion site could result in vessel perforation. Standard imaging techniques such as magnetic resonance imaging and digital subtraction angiography often fail to reveal detailed structures beyond the occlusion site. Aortic cone-beam computed tomography, that is cone-beam computed tomography performed using an intraarterial injection of contrast medium from the ascending aorta, has the potential to overcome this limitation by providing a comprehensive view of intracranial vessels. This study investigated whether aortic cone-beam computed tomography could better visualize distal vessels beyond occlusion than other modalities. This retrospective cohort study included patients with acute ischemic stroke who underwent mechanical thrombectomy during 2020-2024. The visibility of distal vessels was scored on a 5-point scale according to the visualized segment of vessels beyond the occlusion site (1 indicates excellent, and 5 indicates poor) and then compared between aortic cone-beam computed tomography and conventional imaging techniques, including digital subtraction angiography and magnetic resonance imaging, using the Wilcoxon signed-rank test. This study included 100 patients. Aortic cone-beam computed tomography resulted in a median visibility score of 2, which was better than those obtained by digital subtraction angiography (2 vs 3, p < 0.001) and magnetic resonance imaging (2 vs 5, p < 0.001). Aortic cone-beam computed tomography improves the visibility of distal vessels beyond occlusion than magnetic resonance imaging and digital subtraction angiography. This may help in safe procedures during mechanical thrombectomy.