CT Angiography in Acute Stroke – Does It Provide Additional Information on Occurrence of Infarction and Functional Outcome after 3 Months?

Abstract

Objective: To investigate whether acute phase intracranial CT angiography (CTA) independently predicts infarction and functional outcome in ischemic stroke. Methods: Hundred and fifty-one consecutive patients with acute (<12 h) ischemic stroke who received intracranial CTA were investigated. Stroke severity on admission was determined using the National Institute of Health Stroke Scale (NIHSS). Reconstructed CTAs were investigated for relevant pathology. Follow-up imaging was performed 24–48 h after admission. Functional outcome was assessed after 3 months using the modified Rankin scale. Single factor and multiple logistic regression analyses were performed to predict infarction and dependency (modified Rankin scale ≧ 3) on follow-up. Results: Median NIHSS on admission was 10 (IQR 3–14). Out of the 151 patients, 61 (40%) had pathological CTA findings. Infarction was demonstrated in 60/61 patients (98%) with and in 67/90 patients (74%) without vessel pathology. Presence of infarction on follow-up imaging and dependency at 3 months were correlated with pathological CTA findings on admission in single factor analysis (each p < 0.001). After adjustment for age (≧/<65 years), NIHSS (≧/<10), sex, therapy, and time to presentation (≧/<3 h), only NIHSS ≧10 on admission was predictive of dependency at follow-up (p < 0.001). Conclusions: Pathological CTA findings in the acute phase of ischemic stroke do not independently predict a poor outcome at 3 months after acute stroke.

Hyperdense Middle Cerebral Artery Sign on Admission CT Scan – Prognostic Significance for Ischaemic Stroke Patients Treated with Intravenous Thrombolysis in the Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Register

“…CT angiography and perfusion imaging may be suggested for early detection of large cerebral artery occlusion [28, 29]. Being the next advance in technology for acute stroke, CT angiography and CT perfusion may provide accurate visualization of vessel occlusion [30,31,32], though some studies question the prognostic significance of its results for long-term outcome [33]. For this reason, the protocol of acute stroke imaging should be as complete as possible according to the local guidelines.…”

Perfusion CT in acute stroke: prediction of vessel recanalization and clinical outcome in intravenous thrombolytic therapy

“…The relationship between baseline CT angiography findings and clinical outcome is rated inconsistently [37,38] in the literature. In contrast to the reported impact of initial CT and MRI angiography findings for clinical outcome in acute stroke patients receiving thrombolysis [29,39], our results did not show a relationship.…”

Added value of multimodal computed tomography imaging: analysis of 1994 acute ischaemic strokes

“…The advent of multi-slice CT perfusion (CTP) provides additional information about tissue status and prognosis [5][6][7]. The combined use of NCCT, CTA and CTP, also called multimodal CT-based imaging (MCTI), has only rarely been assessed with regard to its impact on clinical outcome: some MCTI studies indicate a value in predicting clinical outcome [8][9][10], whereas others do not [11]. More data on the positive association of imaging with clinical outcome are available using multimodal magnetic resonance based imaging (MRI) [12][13][14] Using consecutive AIS patients in a single centre frequently using MCTI, our aim was to study whether MCTI use was associated with benefit or harm to patients, i.e.…”