CT angiography in the rapid triage of patients with hyperacute stroke to intraarterial thrombolysis: Accuracy in the detection of large vessel thrombus

Purpose: The purpose of this work was to evaluate the accuracy of CT angiog raphy (CTA) for the detection of large vessel intracranial thrombus in clin ically suspected hyperacute (<6 h) stroke patients. Method: Forty-four consecutive intraarterial thrombolysis candidates underw ent noncontrast CT followed immediately by CTA. Axial source and two-dimens ional collapsed maximum intensity projection reformatted CTA images were ra ted for the presence or absence of large vessel occlusion. Five hundred sev enty-two circle-of-Willis vessels were reviewed. arteriographic correlation was available for 224 of these. Results: Sensitivity and specificity for the detection of large vessel occl usion were 98.4 and 98.1%: accuracy, calculated using receiver operating ch aracteristic analysis, was 99%, Mean time for acquisition, reconstruction, and analysis of CTA images was approximately 15 min. Conclusion: CTA is highly accurate for the detection and exclusion of large vessel intracranial occlusion and may therefore be valuable in the rapid t riage of hyperacute stroke patients to intraarterial thrombolytic treatment .