Presentation
Successful mechanical thrombectomy performed due to acute right MCA M1 segment occlusion on the day before. Follow-up.
Patient Data
A right perisylvian, partially sulcal/subarachnoidal vividly hyperdense area with smudgy margins can be discerned. In the context of absent clinical deterioration and recent invasive angiography it is suggestive of previously extravasated contrast. Dual-energy CT confirms this as the hyperdense area corresponds to the foci of iodine accumulation on the pseudocolor map.
DynaCT at the end of DSA on...
DynaCT at the end of DSA on the day before
Intraoperative CT done with the C-arm (note reduced quality) after thrombectomy already demonstrates a predominantly sulcal, more circumscribed hyperdensity indicating acutely extravasated blood rich in iodinated contrast.
Case Discussion
Iodine extravasation is not uncommon during/after mechanical thrombectomy procedures. DECT can readily solve the diagnostic dilemma of extravasation vs. hemorrhagic transformation. Having post-procedure intraoperative CTs available for comparison is also paramount.
This case is also contributed by Dr Sándor Szukits.
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