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Updated: Dec 11, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Regional Mechanical Thrombectomy Imaging Protocol in Patients Presenting with Acute Ischemic Stroke during the
P S Dhillon1, K Pointon2, R Lenthall3
1From the Interventional Neuroradiology Department (P.S.D., R.L., S.N., N.M., W.I.), Queen's Medical Centre, Nottingham University Hospitals National Health Service Trust, Nottingham, UK permesh.dhillon@nhs.net.
Insights
Chest CT scans are effective for screening coronavirus disease 2019 (COVID-19) in stroke patients undergoing mechanical thrombectomy. This rapid tool aids risk stratification without delaying critical treatments.
Area of Science:
- Neurology
- Radiology
- Infectious Diseases
Background:
- Emergent procedures require rapid screening for coronavirus disease 2019 (COVID-19).
- Chest CT is a valuable tool for COVID-19 screening.
Purpose of the Study:
- To assess the feasibility and outcomes of a modified imaging algorithm for COVID-19 risk stratification.
- To evaluate the use of chest CT in acute ischemic stroke patients undergoing mechanical thrombectomy.
Main Methods:
- Retrospective review of 49 patients undergoing mechanical thrombectomy.
- Implementation of a standard imaging protocol including chest CT, head CT, and CT angiogram.
- Comparison of chest CT findings with COVID-19 test results.
Main Results:
- Chest CT demonstrated 100% sensitivity and 74.1% specificity for diagnosing COVID-19.
- Mean additional time for chest CT was 184 seconds with a radiation dose of 2.47 mSv.
- Identified incidental cardiovascular and pulmonary findings.
Conclusions:
- Chest CT is a pragmatic tool for COVID-19 risk stratification in mechanical thrombectomy candidates.
- Integrating chest CT into stroke imaging protocols enhances efficiency without delaying treatment.
Background And Purpose:
Chest CT is a rapid, useful additional screening tool for coronavirus disease 2019 (COVID-19) in emergent procedures. We describe the feasibility and interim outcome of implementing a modified imaging algorithm for COVID-19 risk stratification across a regional network of primary stroke centers in the work-up of acute ischemic stroke referrals for time-critical mechanical thrombectomy.
Materials And Methods:
We undertook a retrospective review of 49 patients referred to the regional neuroscience unit for consideration of mechanical thrombectomy between April 14, 2020, and May 21, 2020. During this time, all referring units followed a standard imaging protocol that included a chest CT in addition to a head CT and CT angiogram to identify Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infective pulmonary changes.
Results:
Overall, 2 patients had typical COVID-19 radiologic features and tested positive, while 7 patients had indeterminate imaging findings and tested negative. The others had normal or atypical changes and were not diagnosed with or suspected of having COVID-19. There was an overall sensitivity of 100%, specificity of 74.1%, negative predictive value of 100%, and positive predictive value of 22.2% when using chest CT to diagnose COVID-19 in comparison with the real-time reverse transcriptase-polymerase chain reaction test. The mean additional time and radiation dose incurred for the chest CT were 184 ± 65.5 seconds and 2.47 ± 1.03 mSv. Multiple cardiovascular and pulmonary incidental findings of clinical relevance were identified in our patient population.
Conclusions:
Chest CT provides a pragmatic, rapid additional tool for COVID-19 risk stratification among patients referred for mechanical thrombectomy. Its inclusion in a standardized regional stroke imaging protocol has enabled efficient use of hospital resources with minimal compromise or delay to the overall patient treatment schedule.
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