CTA of the head has a high sensitivity and specificity for the detection of intracranial LVO [60]. Acute stroke possibly due to LVO is a true medical emergency requiring rapid diagnosis, and the use of CTA of the head for the initial test in the detection of LVO is supported by multiple RCTs and is the preferred means of LVO detection due to the time-sensitive nature of stroke care [44,46,48,49,57]. Moreover, in the absence of an LVO, other etiologies such as atherosclerosis, vasculitis, reversible cerebral vasoconstrictive syndrome, or other etiologies may be suggested by CTA of the head. CTA Neck With IV Contrast CTA of the neck is the most rapid means of assessment of the extracranial vasculature in the setting of stroke. CTA of the neck can be rapidly acquired together with CTA of the head, can further elucidate the etiology of the stroke, and may be useful for endovascular surgical planning for EVT in LVO [13]. Specifically, the degree of vascular tortuosity is directly correlated with the time from groin puncture to recanalization and must be factored into the decision-making process both with regards to indications and surgical approach, including the choice of access using radial artery or direct carotid puncture approach [61]. Current AHA guidelines recommend noninvasive imaging of the cervical carotid arteries for patients with TIA or minor stroke who are candidates for CEA or stenting, within 48 hours of onset [12]. CTV Head With IV Contrast There is no relevant literature to support the use of CTV head in the evaluation of suspected ischemic stroke in the absence of suspicion for CVT. MRA Head Without and With IV Contrast There is no relevant literature to support the use of contrast-enhanced MRA of the head in the evaluation of suspected ischemic stroke. MRA Head Without IV Contrast TOF MRA of the head is sensitive and specific in the detection of LVO and characterization of intracranial atherosclerosis.
Cerebrovascular Diseases Stroke and Stroke Related Conditions PCAs. CTA of the head has a high sensitivity and specificity for the detection of intracranial LVO [60]. Acute stroke possibly due to LVO is a true medical emergency requiring rapid diagnosis, and the use of CTA of the head for the initial test in the detection of LVO is supported by multiple RCTs and is the preferred means of LVO detection due to the time-sensitive nature of stroke care [44,46,48,49,57]. Moreover, in the absence of an LVO, other etiologies such as atherosclerosis, vasculitis, reversible cerebral vasoconstrictive syndrome, or other etiologies may be suggested by CTA of the head. CTA Neck With IV Contrast CTA of the neck is the most rapid means of assessment of the extracranial vasculature in the setting of stroke. CTA of the neck can be rapidly acquired together with CTA of the head, can further elucidate the etiology of the stroke, and may be useful for endovascular surgical planning for EVT in LVO [13]. Specifically, the degree of vascular tortuosity is directly correlated with the time from groin puncture to recanalization and must be factored into the decision-making process both with regards to indications and surgical approach, including the choice of access using radial artery or direct carotid puncture approach [61]. Current AHA guidelines recommend noninvasive imaging of the cervical carotid arteries for patients with TIA or minor stroke who are candidates for CEA or stenting, within 48 hours of onset [12]. CTV Head With IV Contrast There is no relevant literature to support the use of CTV head in the evaluation of suspected ischemic stroke in the absence of suspicion for CVT. MRA Head Without and With IV Contrast There is no relevant literature to support the use of contrast-enhanced MRA of the head in the evaluation of suspected ischemic stroke. MRA Head Without IV Contrast TOF MRA of the head is sensitive and specific in the detection of LVO and characterization of intracranial atherosclerosis.