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Updated: May 28, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Emerging impact of CTA/perfusion CT on acute stroke thrombolysis in a community hospital
M N Brant-Zawadzki1, D M Brown, L A Whitaker
1Department of Radiology, Hoag Memorial Hospital Neurosciences Center, Newport Beach, California, USA. mbrant@hoaghospital.org
Insights
Advanced CT imaging, including CT angiography (CTA) and perfusion CT (pCT), identifies salvageable brain tissue in acute stroke patients, improving treatment outcomes in community hospitals.
Area of Science:
- Neuroradiology
- Cerebrovascular Diseases
- Emergency Medicine
Background:
- Hyperacute stroke management requires rapid and accurate diagnostic tools.
- Thrombolytic therapy is time-sensitive and benefits from precise patient selection.
- Community hospitals face challenges in implementing advanced stroke imaging protocols.
Purpose of the Study:
- To evaluate the role of CT, CTA, and pCT in hyperacute stroke patients.
- To assess the effectiveness of these advanced imaging techniques in identifying ischemic tissue and guiding thrombolysis.
- To determine if advanced CT protocols improve patient outcomes in a community hospital setting.
Main Methods:
- Retrospective review of 50 hyperacute stroke patients treated within 6 hours of symptom onset.
- Evaluation of multidetector CT, CTA, and pCT imaging studies.
- Correlation with clinical data, outcomes, and subsequent imaging.
Main Results:
- CT blood volume defect predicted permanent infarct in 14 patients.
- Arterial clot identified in 28/37 CTAs (carotid, MCA, vertebrobasilar).
- Viable penumbra identified in 20/37, with 14 showing rescued penumbra post-treatment.
- 58% of patients showed clinical improvement, with 3 complete recoveries.
- Advanced CT was more sensitive to ischemia than routine CT, aiding robust patient triage.
Conclusions:
- Advanced CT (CTA/pCT) is more sensitive for detecting ischemia than routine CT.
- Salvageable penumbra can be identified, enabling targeted thrombolytic therapy.
- Utilizing CT/CTA/pCT for patient triage in acute stroke improves outcomes in community hospitals.
Abstract:
Our objective was to retrospectively review the emerging role of CT, CTA, and perfusion CT (pCT) in the hyperacute stroke population of a community hospital. We reviewed 50 consecutive patients' records and imaging studies, who were treated with thrombolytic therapy within 6 h of symptom onset. Multidetector CT, CTA, and pCT studies were evaluated. Subsequent CT, magnetic resonance, or angiographic studies when available were correlated. Patients' clinical data at admission and outcomes at discharge were evaluated. Complications were tabulated. Of the 50 patients treated with thrombolytics, 37 had CT/CTA/pCT, the others non-contrast CT only. CT blood volume defect was present in a total of 14 patients, presaging permanent infarct in all. Arterial clot was seen in 28/37 CTAs (carotid "T" 6, MCA 16, vertebrobasilar 6). Viable penumbra was shown in 20/37; rescued penumbra was depicted after treatment in 14. 39 patients were treated with intravenous, nine with intra-arterial, two with both forms of thrombolysis. Modified Rankin score showed clinical improvement in 58%, three patients had complete recovery. Subsequent bleed was shown in two (4%), symptomatic in one (2%). Two patients died. Our experience suggests advanced CT is more sensitive to ischemia than routine CT, that salvageable penumbra can be identified, and that triage of patients with acute stroke for thrombolysis with CT/CTA/pCT is more robust than routine CT alone, and may improve outcomes in the community hospital setting.
