"CTA for All": Emergency CT Angiography for All Stroke Patients Presenting Within 24 Hours of Onset Improves Outcome After Large Vessel Occlusion
Mayer S, Viarasilpa T, Panyavachiraporn N, Griffith B, Miller D, Brady M, Scozzari D, Katramados A, Hefzy H, Malik S, Marin H, Kole M, Abou-Chebl A, Lewandowski C, and Mitsias P. "CTA for All": Emergency CT Angiography for All Stroke Patients Presenting Within 24 Hours of Onset Improves Outcome After Large Vessel Occlusion. Stroke 2019; 50.
Introduction: Computed tomographic angiography (CTA) is an important initial assessment for detecting large vessel occlusion (LVO) in acute ischemic stroke (AIS) and for selecting patients for mechanical thrombectomy (MT). This study is designed to evaluate the impact of an emergency CTA protocol on outcome of AIS patients with LVO. Methods: On July 1, 2017 we implemented the policy of performing CTA at the same time as non-contrast CT (NCCT) in all AIS patients presenting within 24 hours of symptom onset regardless of baseline NIHSS. Previously emergency CTA was reserved for patients presenting within 6 hours with an NIHSS ≥6. We compared treatment processes and outcomes between AIS patients admitted 1-year before (N=396) and 1-year after (N=494) protocol implementation. Results: After protocol implementation, more patients underwent CTA (90% VS 60%, P < 0.001) and had CTA performed at the time of the initial NCCT (77% VS 34%, P