Importance of computed tomography angiography in acute/hyperacute ischemic stroke

To evaluate the importance of computed tomography and computed tomography angiography (CTA) in stroke protocols, as well as their impact on endovascular treatment and on the determination of the etiology.

Were evaluated 28 patients with acute/hyperacute stroke in the anterior circulation who underwent intracranial and cervical CTA between April 2018 and August 2019. The parameters evaluated were the degree of stenosis, plaque characteristics, type of infarct, treatment, etiology, and the Alberta Stroke Program Early CT Score (ASPECTS).

Of the 28 patients evaluated, 16 (57.1%) had an ASPECTS of 10 (the maximum score, indicative of normality). Four patients (14.3%) underwent thrombolytic treatment, and seven (25.0%) underwent mechanical thrombectomy. The etiology was atherosclerosis in 32.1% of the patients, cerebral small-vessel disease in 7.1%, cardioembolic in 7.1%, and undetermined in 53.6%. Regarding plaque, 17.9% of the patients presented stenosis ≥ 50%, 21.4% presented stable plaques, and 42.9% presented vulnerable plaques. Patients with a lower ASPECTS were more likely to have relevant stenosis and were more likely to have a total infarct.

In the evaluation of patients with acute/hyperacute strokes, CTA provides important information, identifying occlusion, as well as helping define the etiology and inform decisions regarding treatment.