CT cervico-cerebral angiography in acute stroke. Can we justify aortic arch imaging?

Sugrue, Gavin; O’Reilly, Martin; Byrne, Danielle; Crockett, Matthew Thomas; Murphy, Seán; Kavanagh, Eoin C.

doi:10.1007/s11845-018-1888-9

Cited by 4 publications

(5 citation statements)

References 41 publications

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“…13,14 Computed tomography angiography is primarily used to assess for the presence of a large-vessel occlusion (LVO) and obtain a vascular roadmap for EVT procedure planning. 15,16 The location and length of thrombus should be recorded 17 with thrombus length >8 mm less likely to resolve with IV tissue plasminogen activator alone. 18 Tips M1 occlusion will typically result in basal ganglia infarction.…”

Section: Computed Tomography Angiogrammentioning

confidence: 99%

CT Imaging of Acute Ischemic Stroke

et al. 2020

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Although acute ischemic stroke remains one of the most common causes of death and disability worldwide, it is a potentially treatable condition if appropriately managed in a timely manner. The goals of acute stroke imaging include establishing a diagnosis as fast as possible with (1) accurate infarct quantification, (2) intracranial and cervical vasculature assessment, and (3) brain perfusion analysis for detection of infarct core and potentially salvageable penumbra allowing optimal patient selection for appropriate therapy. Given the extensive number of images generated from acute stroke imaging studies and as “time is brain,” this article aims to highlight a logical approach for the radiologist in acute stroke computed tomography imaging in order to accurately interpret and communicate results in a timely manner.

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Section: Computed Tomography Angiogrammentioning

confidence: 99%

CT Imaging of Acute Ischemic Stroke

et al. 2020

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“…Deipolyi et al concluded that no information relevant to acute patient management was found in the chest portion of CTA, but this part accounted for approximately 50% of the effective dose of the CT scan. Sugrue et al 16 found only 0.33% relevant vascular findings in the upper chest region in their patient cohort and therefore asked for further prospective studies adopting narrower FOVs, excluding the upper chest. They recommended an FOV from the C6/C7 disc space to the skull vertex.…”

Section: Discussionmentioning

confidence: 98%

“…10,13,14 Only limited data are available regarding the utility of CTA imaging from the aortic arch to the skull vertex. 15,16 Currently, medical imaging is the largest man-made source of radiation exposure to the general population and has been increasing over the past decade owing to the increasing use of computed tomography (CT) imaging. 17 Although diagnostic imaging is widely accepted as a fundamental tool in diagnostic workup, it is generally accepted that ionizing radiation is a risk factor for the development of cancer.…”

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confidence: 99%

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Diagnostic Value of Computed Tomography Angiography in Suspected Acute Ischemic Stroke Patients With Respect to National Institutes of Health Stroke Scale Score

Andree

Thanabalasingam

Teubner

et al. 2023

J Comput Assist Tomogr

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ObjectiveNoncontrast computed tomography (NCCT) plus computed tomography angiography (CTA) is the standard imaging modality for acute stroke. We investigated whether there is an additional diagnostic value of supra-aortic CTA in relation to National Institutes of Health Stroke Scale (NIHSS) and resultant effective radiation dose.MethodsIn this observational study, 788 patients with suspected acute stroke were included and divided into 3 NIHSS groups: group 1, NIHSS 0–2; group 2, NIHSS 3–5; and group 3, NIHSS ≥ 6.Computed tomography scans were assessed for findings of acute ischemic stroke and vascular pathologies in 3 regions. Final diagnosis was obtained from medical records. Effective radiation dose was calculated based on the dose-length product.ResultsSeven hundred forty-one patients were included. Group 1 had 484 patients, group 2 had 127 patients, and group 3 had 130 patients. Computed tomography diagnosis of acute ischemic stroke was made in 76 patients. In 37 patients, a diagnosis of acute stroke was made based on pathologic CTA findings in case of an unremarkable NCCT. Stroke occurrence was the lowest in groups 1 and 2, with 3.6% and 6.3%, respectively, compared with 12.7% in group 3. If both NCCT and CTA were positive, the patient was discharged with a stroke diagnosis. Male sex had the highest effect on the final stroke diagnosis. The mean effective radiation dose was 2.6 mSv.ConclusionsIn female patients with NIHSS 0–2, additional CTA rarely contains relevant additional findings decisive for treatment decisions or overall patient outcomes; therefore, CTA in this patient group might yield less impactful findings, and the applied radiation dose could be lowered by approximately 35%.

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“…The utility of a CTA protocol has been established, but the scope of CT imaging is controversial 8. The first benefit of inclusion of chest CT is that it is possible to rule out fatal mimics of acute ischaemic stroke such as acute aortic dissection 9. The second benefit is that it enables determination of the aetiology of acute ischaemic stroke such as atherosclerotic burden, occult cancer and PAVM 10 11.…”

Section: Discussionmentioning

confidence: 99%

CT chest-cerebral angiography for basilar artery occlusion caused by pulmonary arteriovenous malformation

et al. 2023

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Early diagnosis of basilar artery occlusion (BAO) based only on clinical findings is challenging. We present a fully recovered case of BAO caused by pulmonary arteriovenous malformation (PAVM) that was diagnosed early using a protocol for CT angiography (CTA) and promptly treated with endovascular therapy (EVT). A woman in her 50s complained of vertigo with normal level of consciousness (LOC). On arrival, her LOC decreased to a Grass Coma Scale score of 12, and we performed a CT chest-cerebral angiography protocol. Head CTA showed BAO, and an intravenous tissue plasminogen activator was administered, followed by EVT. Chest contrast-enhanced CT showed PAVM in segment 10 of the left lung, which was treated with coil embolisation. For patients with a complaint of vertigo, BAO should be suspected, even if they have an initially normal LOC. A CT chest-cerebral angiography protocol is useful for prompt diagnosis and treatment of BAO and can reveal undetermined causes.

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CT cervico-cerebral angiography in acute stroke. Can we justify aortic arch imaging?

Cited by 4 publications

References 41 publications

CT Imaging of Acute Ischemic Stroke

CT Imaging of Acute Ischemic Stroke

Diagnostic Value of Computed Tomography Angiography in Suspected Acute Ischemic Stroke Patients With Respect to National Institutes of Health Stroke Scale Score

CT chest-cerebral angiography for basilar artery occlusion caused by pulmonary arteriovenous malformation

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