CT angiography helps decision-making in referral hospitals for stroke patients

Researchers examined how vascular imaging at referring hospitals may provide an avenue for better informed decisions by a care team in determining transfers for thrombectomy.

Focusing primary on the use of CT angiography (CTA), the study, from a group led by Gregoire Boulouis, MD, MSc, with Massachusetts General Hospital and Harvard Medical Center, was published online Sept. 25 in JAMA: Neurology.

“In a stroke network setting, vascular imaging to identify intracranial occlusions and assess collateral blood vessels may provide an additional tool for determining triage decisions when transferring a patient to a TCSC,” wrote Boulouis et al.

Researchers found decaying Alberta Stroke Program Early CT Scores (ASPECTS) were strongly connected to the severity of stroke and poor collateral circulation. A 5.14-fold increased risk of ASPECTS worsening from six or high to less than six correlated to poor or no leptomeningeal collateral blood flow, as measured by CTA.

The retrospective studied examined the cases of 316 patients, with 19.6 percent seeing ASPECTS reduction. That percentage increased to 89 percent for patients who showed poor collateral blood flow at the second center a median of 3.2 hours after presentation at the initial hospital.

The analysis included patients transferred from one of 30 referring hospitals to a thrombectomy-capable stroke center (TCSC). Individuals were tested via CT at the referring hospital and CTA at the destination center—suggesting earlier CTA may be necessary to provide a better risk assessment.

In an accompanying editorial, Bruce Campbell, MBBS, PhD, stressed the importance of CTA occurring immediately after noncontrast CT.

“The new era of thrombectomy in an extended time window is particularly relevant to regional centers with long transfer times, and eligibility is critically dependent on collateral imaging,” he wrote. “It makes clinical and economic sense to identify these patients at initial assessment rather than indiscriminately transferring patients who have no chance of proceeding to thrombectomy.”