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International Journal of Emergency Medicine

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Open Access 01-12-2011 | Original Research

CT angiography predicts use of tertiary interventional services in acute ischemic stroke patients

Authors: Lisa E Thomas, Joshua N Goldstein, Reza Hakimelahi, Yuchiao Chang, Albert J Yoo, Lee H Schwamm, R Gilberto Gonzalez

Published in: International Journal of Emergency Medicine | Issue 1/2011

Abstract

Background

Patients with acute stroke are often transferred to tertiary care centers for advanced interventional services. We hypothesized that the presence of a proximal cerebral artery occlusion on CT angiography (CTA) is an independent predictor of the use of these services.

Methods

We performed a historical cohort study of consecutive ischemic stroke patients presenting within 24 h of symptom onset to an academic emergency department who underwent emergent CTA. Use of tertiary care interventions including intra-arterial (IA) thrombolysis, mechanical clot retrieval, and neurosurgery were captured.

Results

During the study period, 207/290 (71%) of patients with acute ischemic stroke underwent emergent CTA. Of the patients, 74/207 (36%) showed evidence of a proximal cerebral artery occlusion, and 22/207 (11%) underwent an interventional procedure. Those with proximal occlusions were more likely to receive a neurointervention (26% vs. 2%, p < 0.001). They were more likely to undergo IA thrombolysis (9% vs. 0%, p = 0.001) or a mechanical intervention (19% vs. 0%, p < 0.0001), but not more likely to undergo neurosurgery (5% vs. 2%, p = 0.2). After controlling for the initial NIH stroke scale (NIHSS) score, proximal occlusion remained an independent predictor of the use of neurointerventional services (OR 8.5, 95% CI 2.2-33). Evidence of proximal occlusion on CTA predicted use of neurointervention with sensitivity of 82% (95% CI 59-94%), specificity of 71% (95% CI 64%-77%), positive predictive value (PPV) of 25% (95% CI 16%-37%), and negative predictive value (NPV) of 97% (95% CI 92%-99%).

Conclusion

Proximal cerebral artery occlusion on CTA predicts the need for advanced neurointerventional services.

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Title: CT angiography predicts use of tertiary interventional services in acute ischemic stroke patients
Authors: Lisa E Thomas
Joshua N Goldstein
Reza Hakimelahi
Yuchiao Chang
Albert J Yoo
Lee H Schwamm
R Gilberto Gonzalez
Publication date: 01-12-2011
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Emergency Medicine / Issue 1/2011
Print ISSN: 1865-1372
Electronic ISSN: 1865-1380
DOI: https://doi.org/10.1186/1865-1380-4-62

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

CT angiography predicts use of tertiary interventional services in acute ischemic stroke patients

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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