Fusion Imaging in Endovascular Thrombectomy for Acute Ischemic Stroke.

Background: Recanalization sometimes fails during endovascular thrombectomy due to target vessel access failure. Two-dimensional/3-dimensional fusion imaging in the Siemens ARTIS Icono biplane platform may facilitate access by fusing the preoperative computed tomography angiography with procedural imaging. This observational study aimed to evaluate vascular access, success rates, and procedure times in endovascular thrombectomies with fusion imaging compared to standard treatment. Methods: Patients treated with endovascular thrombectomy for ischemic stroke at Skåne University Hospital in Lund, Sweden, were consecutively included. Baseline and procedural characteristics were gathered from radiological patient records. Procedural success rate and lead times such as groin-to-recanalization times were evaluated. Associations between fusion imaging and first-pass recanalization and groin to first pass <30 minutes were also assessed. Results: Of 347 patients, fusion imaging was used in 68 cases. Failure to reach the occlusion occurred in 6 (2%) of the nonfusion cases compared with none in the fusion group. Successful recanalization (modified Treatment in Cerebral Infarction score ≥2b) was obtained in all fusion cases, compared with 86% in the nonfusion group (P = 0.001). First-pass recanalization occurred in 72% and 49% of the fusion and nonfusion groups respectively (P<0.001). The groin-to-recanalization time was significantly shorter in fusion cases compared with nonfusion (33 versus 43 min, P = 0.04). When adjusting for age and sex, fusion was significantly associated with first-pass recanalization (odds ratio, 2.70; [95% CI, 1.51-4.86]; P<0.001). Conclusion: Fusion imaging use in the Siemens ARTIS Icono biplane platform in endovascular thrombectomy is not associated with worsened procedural results and appears to decrease failed target artery access risk and increase procedural success rate as well as first-pass success rate, without procedure prolongation. These initial observational findings need to be further evaluated in prospective randomized studies.