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Updated: May 21, 2026
09:21
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Routine CT angiography in acute stroke does not delay thrombolytic therapy
Simerpreet Bal1, Bijoy K Menon, Andrew M Demchuk
1Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
Summary
Computed tomographic angiography (CTA) does not delay acute ischemic stroke thrombolysis. This study found no significant difference in door-to-needle times between CTA-based and non-contrast CT scan protocols, supporting its routine use.
Area of Science:
- Neurology
- Radiology
- Emergency Medicine
Background:
- Routine computed tomographic angiography (CTA) for acute ischemic stroke is debated due to concerns about utility and potential delays in treatment.
- This study compares treatment interval times between a CTA-based protocol and a previous non-contrast CT scan (NCCT) protocol.
Purpose of the Study:
- To evaluate if implementing a CTA-based protocol for acute ischemic stroke management significantly impacts door-to-needle time compared to an NCCT-based protocol.
- To assess the overall efficiency of stroke thrombolysis workflows with and without routine CTA.
Main Methods:
- A retrospective review of 850 acute ischemic stroke thrombolysis patients treated between April 1996 and December 2009.
- Patients were divided into two groups: Group 1 (NCCT-based, n=297) and Group 2 (CTA-based, n=504), with a washout period in between.
- Key interval times (onset-to-door, door-to-needle, onset-to-needle) were compared between the groups.
Main Results:
- Median onset-to-door times were 55 minutes for Group 1 and 61 minutes for Group 2 (p=0.019).
- Median door-to-needle times were 67 minutes for Group 1 and 62.5 minutes for Group 2 (p=0.519).
- Median onset-to-needle times were 139 minutes for Group 1 and 141.5 minutes for Group 2 (p=0.468). Age and onset-to-door time were found to influence door-to-needle time.
Conclusions:
- A CTA-based thrombolytic approach for acute ischemic stroke does not significantly delay treatment in routine clinical practice.
- The findings suggest that CTA can be safely integrated into acute ischemic stroke protocols without compromising timely thrombolysis.
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