Purpose
Advanced CT techniques have become the standard of care in acute stroke management in many tertiary centers. The two primary treatments available to clinicians in the hyperacute setting of ischaemic stroke are generally recognised to be IV thrombolysis and Endovascular Clot Retrieval (ECR). There is sufficient evidence to suggest advanced imaging predicts response to both treatments in the early phases of management (1-9). The recent EXTEND trial builds a strong case for thrombolysis up to 9 hours in patients with a favourable perfusion scan (1)...
Methods and materials
This was a five-month audit, including all patients who underwent a complete stroke protocol over the period between the 3rd November 2018 and the 3rd April 2019. A complete stroke protocol was defined as a Non-Contrast CT Brain (NCCTB), CT Carotid Angiogram (CTCA) and a CT Neuroperfusion (CTP) scan.
Dose data was recorded for all patients, including DLP and CTDIvol. The average dose was calculated across all patients for all three scans. The average effective dose was calculated (mSv) using the DLP and CT Expo...
Results
124 stroke protocols were completed in the five-month period. Three studies were excluded as their data sets were incomplete. Two patients with hypoperfusion syndrome due to long standing anterior circulation disease were not considered to be thrombolysis or ECR candidates. Of the 121 patients included in the audit, 66.2 % ended up with a final diagnosis of stroke, 11.6 % were suitable for thrombolysis and 9.9 % were clot retrieval candidates (Figure 1). One patient was considered a clot retrieval candidate that had a basilar...
Conclusion
This audit revealed that stroke is common in patients selected by our stroke service for a CT based stroke protocol. A large portion of patients shown to have a stroke were suitable for either thrombolysis or ECR, both of which have good evidence for improving function outcomes with imaging guided decision making (1-9).
The dose related risk associated with these scans is low, even in younger females, as the brain is particularly radio-resistant.
When comparing the radiation risk to the potential benefit of reperfusion therapy,...
Personal information
Dr Nicholas D'arcy (MBBS (Hons), BappSc, OLY)
Resident at the Sunshine Coast University Hospital. Initially studied medical imaging at QUT, while competing for Australia at the 2012 Olympic Games in swimmming. Went on to study medicine in 2014 at UQ, graduating with first class honours in 2017.
Published in Journal of Medicinal Chemistry and Pigmented Cell and Melanoma Reserach on selective approaches to melanoma therapies. Developed a passion for stroke during an observership to Mount Sinai Hospital, New York under the guidance of Dr Reade...
References
1.Ma H, Campbell BCV, Parsons MW, Churilov L, Levi CR, Hsu C, et al. Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke. N Engl J Med. 2019;380(19):1795-803.
2.Bivard A, Lou M, Levi CR, Krishnamurthy V, Cheng X, Aviv RI, et al. Too good to treat? ischemic stroke patients with small computed tomography perfusion lesions may not benefit from thrombolysis. Ann Neurol. 2016;80(2):286-93.
3.Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, et al. Thrombectomy for Stroke at...