%0 Journal Article
%T CT angiography predicts use of tertiary interventional services in acute ischemic stroke patients
%A Lisa E Thomas
%A Joshua N Goldstein
%A Reza Hakimelahi
%A Yuchiao Chang
%A Albert J Yoo
%A Lee H Schwamm
%A R Gonzalez
%J International Journal of Emergency Medicine
%D 2011
%I BioMed Central
%R 10.1186/1865-1380-4-62
%X We performed a historical cohort study of consecutive ischemic stroke patients presenting within 24 h of symptom onset to an academic emergency department who underwent emergent CTA. Use of tertiary care interventions including intra-arterial (IA) thrombolysis, mechanical clot retrieval, and neurosurgery were captured.During the study period, 207/290 (71%) of patients with acute ischemic stroke underwent emergent CTA. Of the patients, 74/207 (36%) showed evidence of a proximal cerebral artery occlusion, and 22/207 (11%) underwent an interventional procedure. Those with proximal occlusions were more likely to receive a neurointervention (26% vs. 2%, p < 0.001). They were more likely to undergo IA thrombolysis (9% vs. 0%, p = 0.001) or a mechanical intervention (19% vs. 0%, p < 0.0001), but not more likely to undergo neurosurgery (5% vs. 2%, p = 0.2). After controlling for the initial NIH stroke scale (NIHSS) score, proximal occlusion remained an independent predictor of the use of neurointerventional services (OR 8.5, 95% CI 2.2-33). Evidence of proximal occlusion on CTA predicted use of neurointervention with sensitivity of 82% (95% CI 59-94%), specificity of 71% (95% CI 64%-77%), positive predictive value (PPV) of 25% (95% CI 16%-37%), and negative predictive value (NPV) of 97% (95% CI 92%-99%).Proximal cerebral artery occlusion on CTA predicts the need for advanced neurointerventional services.Regional systems of care have been established in some localities, where acute ischemic stroke patients are preferentially admitted to "stroke centers" [1,2]. However, no formal guidelines exist for determining which patients should be transferred from a primary stroke center (PSC), capable of administering thrombolysis, to a comprehensive stroke center (CSC), with advanced services including endovascular capabilities. As a result, there can be tremendous heterogeneity in which patients remain at a PSC versus which are transferred to a CSC. Furthermore, many PSCs are likely
%U http://www.intjem.com/content/4/1/62