CTA-for-All

Abstract

Background and Purpose— We sought to evaluate the impact of a Computed Tomographic Angiography (CTA) for All emergency stroke imaging protocol on outcome after large vessel occlusion (LVO). Methods— On July 1, 2017, the Henry Ford Health System implemented the policy of performing CTA and noncontrast computed tomography together as an initial imaging study for all patients with acute ischemic stroke (AIS) presenting within 24 hours of last known well, regardless of baseline National Institutes of Health Stroke Scale score. Previously, CTA was reserved for patients presenting within 6 hours with a National Institutes of Health Stroke Scale score ≥6. We compared treatment processes and outcomes between patients with AIS admitted 1 year before (n=388) and after (n=515) protocol implementation. Results— After protocol implementation, more AIS patients underwent CTA (91% versus 61%; P <0.001) and had CTA performed at the same time as the initial noncontrast computed tomography scan (78% versus 35%; P <0.001). Median time from emergency department arrival to CTA was also shorter (29 [interquartile range, 16–53] versus 43 [interquartile range, 29–112] minutes; P <0.001), more cases of LVO were detected (166 versus 96; 32% versus 25% of all AIS; P =0.014), and more mechanical thrombectomy procedures were performed (108 versus 68; 21% versus 18% of all AIS; P =0.196). Among LVO patients who presented within 6 hours of last known well, median time from last known well to mechanical thrombectomy was shorter (3.5 [interquartile range, 2.8–4.8] versus 4.1 [interquartile range, 3.3–5.6] hours; P =0.038), and more patients were discharged with a favorable outcome (Glasgow Outcome Scale 4–5, 53% versus 37%; P =0.029). The odds of having a favorable outcome after protocol implementation was not significant (odds ratio, 1.84 [95% CI, 0.98–3.45]; P =0.059) after controlling for age and baseline National Institutes of Health Stroke Scale score. Conclusions— Performing CTA and noncontrast computed tomography together as an initial assessment for all AIS patients presenting within 24 hours of last known well improved LVO detection, increased the mechanical thrombectomy treatment population, hastened intervention, and was associated with a trend toward improved outcome among LVO patients presenting within 6 hours of symptom onset.

The emergency department incidence of incidental intracranial aneurysm on computed tomography angiography (EPIC-ACT) study

“…We identified 36 incidental intracranial aneurysms resulting in an incidence proportion of 3.3% (95% CI 2.3-4.6). 10 (27.8%) of the patients had multiple aneurysms (1)(2)(3)(4). Locations of the identified aneurysms varied with 23 located in the internal carotid artery, 9 in the middle cerebral artery and 8 in the anterior cerebral artery.…”

“…Computed tomography angiography (CTA) is an established tool with several clinical indications in the emergency department (ED) including evaluation of suspected stroke syndromes [1].…”

CTA Protocols in a Telestroke Network Improve Efficiency for Both Spoke and Hub Hospitals

“…A health system in Detroit expanded CTA imaging to all patients with stroke after previously reserving it for patients with NIHSS scores $6 points. 29 CTA scanning for all suspected patients with stroke led to increased rates of ELVO detection, increased mechanical thrombectomy treatment, and a possible trend toward improved outcomes in that system (a single comprehensive stroke center hub and 8 associated hospitals). By comparison, this present study is novel in describing the effects of CTA triage in SHs within an entire, widely distributed telestroke network where CTA imaging had not been routinely performed previously.…”

“…Furthermore, we selected an NIHSS score threshold of 6 points at the SH based on our clinical practice and guideline recommendations but recognize some patients with ELVOs may have had NIHSS scores ,6 points and may not be captured in these data. 29 A limited number of patients with high NIHSS scores or ELVOs were transferred to other thrombectomy centers, and we do not have details about what proportion of these patients later had confirmed ELVOs or underwent EVT. We focus on system processes and therefore do not detail patient outcomes because of limitations in data available in both the pre-CTA cohort and for patients with confirmed ELVOs transferred to other centers.…”

Fibromuscular Dysplasia/Carotid Web in Angio-CT Imaging: A Rare Cause of Ischemic Stroke

“…The most useful method in the diagnosis of CaW in daily practice appears to be CT angiography (CTA) [ 8 ]. The examination is well tolerated by patients, widely available, associated with a low risk of complications and is routinely performed in the acute phase of ischemic stroke [ 19 , 20 ]. According to some reports, its sensitivity does not differ significantly from that of the DSA examination [ 21 ].…”