title: Expedited computed tomography perfusion and angiography in acute ischemic stroke: a feasibility study.
abstract: BACKGROUND
  Acute ischemic stroke diagnosis and treatment are among the most challenging in Emergency Medicine. Perfusion computed tomography (CTP) can increase the sensitivity for detecting ischemic stroke and, especially with the addition of CT angiography (CTA), improve decision-making regarding thrombolytic therapy compared to non-contrast computed tomography (NCCT) alone. However, because acute stroke protocols do not generally include procedures for multimodal imaging, they are not commonly performed. In addition, there is concern that additional studies could delay or preclude therapy in patients otherwise eligible for thrombolytic therapy.
  
  
  OBJECTIVE
  To demonstrate the feasibility of perfusion CTP and CTA in addition to NCCT of the brain in the emergency assessment of patients with acute ischemic stroke.
  
  
  METHODS
  Starting January 2008, multimodal (CTP and CTA) imaging was added to NCCT in the Emergency Department (ED) initial assessment of patients with stroke of ≤ 5 h duration. Over the subsequent 9 months, we measured the time from ED arrival to imaging and to recombinant tissue plasminogen activator (rt-PA) treatment and compared these times to patients evaluated with CT alone.
  
  
  RESULTS
  From January to October 2008, 95 patients had CTP and CTA studies in addition to NCCT for acute ischemic stroke. There were no differences between the average time to CT study or to rt-PA treatment between patients evaluated with multimodal CT imaging and patients assessed with NCCT alone.
  
  
  CONCLUSIONS
  Combining CTP and CTA with NCCT is feasible and does not adversely increase the time to CT imaging or rt-PA treatment in patients with acute ischemic stroke.
authors.affiliation: Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA.
authors.forename: Nina T
authors.initials: NT
authors.lastname: Gentile
authors.forename: John
authors.initials: J
authors.lastname: Cernetich
authors.forename: Uday S
authors.initials: US
authors.lastname: Kanamalla
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Kochan
authors.forename: Hannah
authors.initials: H
authors.lastname: Reimer
authors.forename: Brent
authors.initials: B
authors.lastname: Freeman
authors.forename: Charles
authors.initials: C
authors.lastname: Jungreis
mesh_terms: D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000188:drug therapy; D002533:Cerebral Angiography; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D010959:Tissue Plasminogen Activator