Expedited Computed Tomography Perfusion and Angiography in Acute Ischemic Stroke: A Feasibility Study

Diagnostic Yield of Emergency Department Arch-to-Vertex CT Angiography in Patients with Suspected Acute Stroke

“…Furthermore, current guidelines for the emergency management of patients with acute stroke remain focused on noncontrast head CT and CTA evaluation only of the intracranial circulation. 1,[16][17] Our primary purpose was to investigate the incidence of diagnostically relevant findings reported in the head, neck, and chest components of an arch-to-vertex CTA performed in the emergency department as part of the immediate evaluation and triage of acute stroke. A secondary aim was to estimate the individual contributions to the total effective dose in these regions.…”

Penumbra and re-canalization acute computed tomography in ischemic stroke evaluation: PRACTISE study protocol

“…Different CTP selection criteria have been used in endovascular trials (45)(46)(47)(48)(49)(50). Observational studies suggest an improved outcome when multimodal imaging is used for patient selection(13) with one centre reporting a threefold increase in thrombolysis rate (52). Some experienced centres using routine multimodal CT report feasibility and safety, with no major delays in door to needle times.…”

“…Some experienced centres using routine multimodal CT report feasibility and safety, with no major delays in door to needle times. (15,52) This, however, might reflect improved efficiency in other aspects of the stroke pathway compensating for a typical 10-15 minutes of extra scanning (52,57,77,78).. Additional imaging may, however, delay treatment initiation and evidence that CTA or CTP features modify treatment effect is so far lacking (55)(56)(57), and clinicians may find the interpretation of multimodal imaging difficult (58). It is possible that multimodal imaging should be utilised in specific subgroups (55,58,79), but these are not currently possible to specify.…”

Accuracy of CT cerebral perfusion in predicting infarct in the emergency department: lesion characterization on CT perfusion based on commercially available software

“…It has been shown that addition of CTP and CTA to NCCT does not adversely increase the time to tPA treatment for acute stroke patients in the ED [11]. However, before widespread utilization of this technique is feasible, further studies are needed in assessing the practical use of CTP with commercially available software as a diagnostic tool for patients presenting with stroke-like symptoms.…”