However, in the setting of highly suspected LVO with no need for perfusion imaging or MRI to determine eligibility for EVT, initial catheter angiography after noncontrast CT may be the preferable vascular imaging study due to the ability to rapidly convert a diagnostic catheter angiogram to EVT [53,54]. More specifically, patients presenting with suspicious signs on noncontrast CT such as hyperdense middle cerebral artery sign with a clear etiology for the LVO such as new onset atrial fibrillation may benefit from proceeding directly to angiography, although prospective data are limited in this regard [55]. CT Head Perfusion With IV Contrast Beyond the early 6-hour time window, determining eligibility for EVT for anterior circulation strokes due to LVO confirmed on CTA in the extended window of 6 to 24 hours may require or be determined by CTP or MR perfusion imaging in some cases [46,57]. Although a major RCT showing benefit of EVT 6 to 24 hours after onset permitted eligibility based on DWI-MRI or CTP [46], the rapidity of diagnosis afforded by CTP is a strongly relevant clinical consideration in this situation in most settings. 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 ischemic stroke. CT Head Without and With IV Contrast There is no relevant literature to support the use of CT of the head with and without contrast in the evaluation of ischemic stroke. Cerebrovascular Diseases-Stroke irreversible tissue damage. Because many RCTs of acute ischemic stroke treatments used the ASPECTS or pc- ASPECTS based on noncontrast CT or DWI-MRI to exclude subjects with large, completed infarcts, an initial noncontrast CT or DWI-MRI is essential for making therapeutic decisions [44,46-49,57-59]. CTA Head With IV Contrast CTA of the head is the most rapid means of assessment of the intracranial vasculature for LVO in the setting of stroke.
Cerebrovascular Diseases Stroke and Stroke Related Conditions PCAs. However, in the setting of highly suspected LVO with no need for perfusion imaging or MRI to determine eligibility for EVT, initial catheter angiography after noncontrast CT may be the preferable vascular imaging study due to the ability to rapidly convert a diagnostic catheter angiogram to EVT [53,54]. More specifically, patients presenting with suspicious signs on noncontrast CT such as hyperdense middle cerebral artery sign with a clear etiology for the LVO such as new onset atrial fibrillation may benefit from proceeding directly to angiography, although prospective data are limited in this regard [55]. CT Head Perfusion With IV Contrast Beyond the early 6-hour time window, determining eligibility for EVT for anterior circulation strokes due to LVO confirmed on CTA in the extended window of 6 to 24 hours may require or be determined by CTP or MR perfusion imaging in some cases [46,57]. Although a major RCT showing benefit of EVT 6 to 24 hours after onset permitted eligibility based on DWI-MRI or CTP [46], the rapidity of diagnosis afforded by CTP is a strongly relevant clinical consideration in this situation in most settings. 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 ischemic stroke. CT Head Without and With IV Contrast There is no relevant literature to support the use of CT of the head with and without contrast in the evaluation of ischemic stroke. Cerebrovascular Diseases-Stroke irreversible tissue damage. Because many RCTs of acute ischemic stroke treatments used the ASPECTS or pc- ASPECTS based on noncontrast CT or DWI-MRI to exclude subjects with large, completed infarcts, an initial noncontrast CT or DWI-MRI is essential for making therapeutic decisions [44,46-49,57-59]. CTA Head With IV Contrast CTA of the head is the most rapid means of assessment of the intracranial vasculature for LVO in the setting of stroke.