Esta es la versión de autor del artículo publicado en: This is an author produced version of a paper published in:Neuroradiology 58.5 (2016) In an adjusted model, baseline CTA-SI-ASPECTS was inversely related to the odds of futile recanalization (OR 0.5; 95 % CI 0.3-0.7), whereas NCCT-ASPECTS was not (OR 0.8; 95 % CI 0.5-1.2). A score ≤5 in CTA-SIASPECTS was the best cut-off to predict futile recanalization (sensitivity 35 %; specificity 97 %; positive predictive value 86 %; negative predictive value 77 %).Conclusions CTA-SI-ASPECTS strongly predicts futile recanalization and could be a valuable tool for treatment decisions regarding the indication of revascularization therapies.Keywords Ischemic stroke . CT-angiography . IntroductionEarly recanalization of the occluded vessel is crucial in improving the prognosis of acute ischemic stroke. However, despite achieving successful and prompt . However, the usefulness of this score for treatment decisions has been debated as it has modest inter-rater reliability, and the majority of recent trials of MT excluded patients with poorer baseline ASPECTS score [6]. ASPECTS on CT angiography source images (CTA-SIASPECTS) has been shown to be a more accurate predictor of outcome and final infarct volume in acute ischemic stroke [7,8]. CTA is recommended for the assessment of site of occlusion and vessel anatomy of acute stroke patients who are potential candidates for endovascular treatment [9], CTA data being available in the majority of these patients during their initial evaluation. The aim of this study is to assess whether baseline CTA-SI-ASPECTS might help predict response to treatment and can reliably predict futile recanalization in patients undergoing reperfusion therapies; the intention being to find a reliable tool for treatment decision making.

This study aimed to determine the effect of an evidence-based clinical decision support (CDS) algorithm on the use and yield of CT pulmonary angiography (CTPA) and on outcomes of patients evaluated in the emergency department (ED) for suspected PE. The study included 1363 consecutive patients evaluated for suspected PE in an ED during 12 months before and 12 months after initiation of CDS use. Introduction of CDS was associated with decreased CTPA use (55% vs 49%; absolute difference (AD), 6.3%; 95% CI 1.0% to 11.6%; p=0.02). The use of CDS was associated with fewer symptomatic venous thromboembolic events during follow-up in patients with an initial negative diagnostic evaluation for PE (0.7% vs 3.2%; AD 2.5%; 95% CI 0.9% to 4.6%; p<0.01).

computed tomographic pulmonary angiography in patients with a high clinical probability of pulmonary embolism. J Thromb Haemost 2016; 14: 114-20. EssentialsWhen high probability of pulmonary embolism (PE), sensitivity of computed tomography (CT) is unclear. We investigated the sensitivity of multidetector CT among 134 patients with a high probability of PE. A normal CT alone may not safely exclude PE in patients with a high clinical pretest probability. In patients with no clear alternative diagnosis after CTPA, further testing should be strongly considered. Summary. Background: Whether patients with a negative multidetector computed tomographic pulmonary angiography (CTPA) result and a high clinical pretest probability of pulmonary embolism (PE) should be further investigated is controversial. Methods: This was a prospective investigation of the sensitivity of multidetector CTPA among patients with a priori clinical assessment of a high probability of PE according to the Wells criteria. Among patients with a negative CTPA result, the diagnosis of PE required at least one of the following conditions: ventilation/perfusion lung scan showing a high probability of PE in a patient with no history of PE, abnormal findings on venous ultrasonography in a patient without previous deep vein thrombosis at that site, or the occurrence of venous thromboembolism (VTE) in a 3-month follow-up period after anticoagulation was withheld because of a negative multidetector CTPA result. Results: We identified 498 patients with a priori clinical assessment of a high probability of PE and a completed CTPA study. CTPA excluded PE in 134 patients; in these patients, the pooled incidence of VTE was 5.2% (seven of 134 patients; 95% confidence interval [CI] 1.5-9.0). Five patients had VTEs that were confirmed by an additional imaging test despite a negative CTPA result (five of 48 patients; 10.4%; 95% CI 1.8-19.1), and two patients had objectively confirmed VTEs that occurred during clinical follow-up of at least 3 months (two of 86 patients; 2.3%; 95% CI 0-5.5). None of the patients had a fatal PE during follow-up. Conclusions: A normal multidetector CTPA result alone may not safely exclude PE in patients with a high clinical pretest probability.