Post-thrombectomy iodine extravasation in ischemic stroke (DECT)

Case contributed by Dr Balint Botz

Presentation

Successful mechanical thrombectomy performed due to acute right MCA M1 segment occlusion on the day before. Follow-up.

Patient Data

Age: 60 years
Gender: Male

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.

CT

DynaCT performed 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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Case information

rID: 79052
Published: 18th Jun 2020
Last edited: 19th Feb 2021
Inclusion in quiz mode: Included
Institution: University of Pécs

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