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Title: Perfusion-derived dynamic 4D CT angiography identifies carotid pseudo-occlusion in hyperacute stroke.
Authors: Gilligan, Amanda
Other Authors: Ng, F. C.
Choi, P. M.
Datta, M.
Keywords: Endovascular Intervention
Acute Stroke
Carotid Pseudo-Occlusion
CT Perfusion
4-Dimensional CT Angiogram
Extracranial Internal Carotid Artery
Acute Tandem Occlusion
Neurosciences Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Nov-2016
Publisher: Wiley Online Library
Citation: J Neuroimaging. 2016 Nov;26(6):588-591. doi: 10.1111/jon.12375
Abstract: BACKGROUND: Differentiation between true acute tandem occlusion involving the extracranial internal carotid artery (ICA) from pseudotandem occlusion with a patent extracranial ICA has important prognostic and therapeutic implications. We explored the utility of perfusion-derived 4-dimensional CT angiogram (4D-CTA) in identifying carotid pseudo-occlusion in a single-center pilot study. METHODS: Acute stroke patients with delayed antegrade ICA flow on 4D-CTA despite an apparent tandem occlusion on conventional single-phase CTA were prospectively identified over a 2.5-year period (2013-2015). RESULTS: Eight patients were identified. Delayed antegrade intracranial flow from the apparently occluded ICA was detected up to 50 seconds after contrast administration on 4D-CTA. The distal intracranial ICA was the most common site of true occlusion. Reconstruction of the 4D-CTA images required an additional processing time of 2-3 minutes. CONCLUSIONS: 4D-CTA is a novel noninvasive technique that can identify carotid pseudo-occlusion in the acute stroke setting. Our preliminary findings suggest that 4D-CTA can be easily incorporated into an existing acute stroke neuroimaging protocol.
DOI: 10.1111/jon.12375
PubMed URL:
ISSN: 1552-6569
Journal Title: Journal of Neuroimaging
Type: Journal Article
Affiliated Organisations: Department of Neurosciences, Box Hill Hospital, Melbourne, Victoria, Australia.
Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
Department of Medical Imaging, Box Hill Hospital, Melbourne, Victoria, Australia.
Type of Clinical Study or Trial: Observational Study
Appears in Collections:Diagnostic Services

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