Arteriography Cervicocerebral Although the spatial resolution of catheter-directed cerebral angiography is higher than any noninvasive technique, cerebral angiography is not preferred as an initial test due to the invasive nature and the diversity of etiologies for TIA. Cerebral angiography may be indicated later in the diagnostic pathway as a secondary examination in the workup of TIA, depending on the suspected underlying etiology and potential indications for endovascular therapy (EVT). CT Head Perfusion With IV Contrast CT perfusion (CTP) can identify abnormalities in the setting of TIA in up to one-third of cases. The detection of an underlying perfusion abnormality may be helpful for risk stratification [14-16]. Specific instances arise in patients with complete extracranial internal carotid artery occlusion in whom CTP can be used to determine its hemodynamic effect [17]. However, selection of patients with carotid occlusion for revascularization based on hemodynamic compromise does not improve outcome [18]. Therefore, CTP is not typically used for the initial assessment of TIA. CT Head With IV Contrast There is no relevant literature to support the use of contrast-enhanced CT of the head in the evaluation of TIA. CT Head Without and With IV Contrast There is no relevant literature to support the use of CT of the head without and with IV contrast in the evaluation of TIA. CT Head Without IV Contrast Noncontrast CT of the head is useful in the initial evaluation of TIA to exclude alternative etiologies and to evaluate for early ischemic changes. Many other lesions may mimic the symptoms of a TIA including intracranial hemorrhage (ICH), infection, and intracranial masses [14,19,20]. Most importantly, ICH must be excluded because it is a contraindication to administration of tissue thrombolytic agents, anticoagulants, and antiplatelet agents used to treat and prevent both TIA and stroke [13].
Cerebrovascular Diseases Stroke and Stroke Related Conditions PCAs. Arteriography Cervicocerebral Although the spatial resolution of catheter-directed cerebral angiography is higher than any noninvasive technique, cerebral angiography is not preferred as an initial test due to the invasive nature and the diversity of etiologies for TIA. Cerebral angiography may be indicated later in the diagnostic pathway as a secondary examination in the workup of TIA, depending on the suspected underlying etiology and potential indications for endovascular therapy (EVT). CT Head Perfusion With IV Contrast CT perfusion (CTP) can identify abnormalities in the setting of TIA in up to one-third of cases. The detection of an underlying perfusion abnormality may be helpful for risk stratification [14-16]. Specific instances arise in patients with complete extracranial internal carotid artery occlusion in whom CTP can be used to determine its hemodynamic effect [17]. However, selection of patients with carotid occlusion for revascularization based on hemodynamic compromise does not improve outcome [18]. Therefore, CTP is not typically used for the initial assessment of TIA. CT Head With IV Contrast There is no relevant literature to support the use of contrast-enhanced CT of the head in the evaluation of TIA. CT Head Without and With IV Contrast There is no relevant literature to support the use of CT of the head without and with IV contrast in the evaluation of TIA. CT Head Without IV Contrast Noncontrast CT of the head is useful in the initial evaluation of TIA to exclude alternative etiologies and to evaluate for early ischemic changes. Many other lesions may mimic the symptoms of a TIA including intracranial hemorrhage (ICH), infection, and intracranial masses [14,19,20]. Most importantly, ICH must be excluded because it is a contraindication to administration of tissue thrombolytic agents, anticoagulants, and antiplatelet agents used to treat and prevent both TIA and stroke [13].