Large artery occlusion diagnosed by computed tomography angiography in acute ischaemic stroke: frequency, predictive factors, and safety.
BACKGROUND
Demonstrating artery occlusion in ischaemic stroke has gained importance due to the increasing availability of endovascular therapies. This study evaluates the frequency of artery occlusion, its associated factors, and complications following the use of CT-angiography in acute stroke.


METHODS
We retrospectively analysed a cohort of patients who suffered acute ischaemic stroke between July and-December 2011.


RESULTS
We included 157 patients (mean age, 74±11; mean NIHSS score, 5 [2-13]). Of that total, 56.7% of the patients were admitted to hospital during the first 8hours. CT-angiography was performed in 71 cases (45.2%); arterial large-vessel occlusion was detected in 37 (52.1%) of these cases, and the most frequent site was M1 (40%). Univariate analysis showed that the NIHSS score (17 vs 7, P<.001) and atrial fibrillation (64% vs 32%, P=.006) were associated with artery occlusion. A logistic regression analysis was performed subsequently, confirming these associations. There were no cases of contrast-induced nephropathy. Door-to-needle time for intravenous thrombolysis was 61.2±24.5minutes in patients who underwent CT-angiography, and 53.5±34.3minutes in those who did not (P=.495).


CONCLUSIONS
Arterial occlusions are seen in 23.6% of patients, especially in those who are admitted during the first few hours. NIHSS score serves as a useful predictive factor.
Servicio de Neurología, Instituto de Neurociencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España. Electronic address: jordimatiasguiu@hotmail.com.
J A
JA
Matias-Guiu
Servicio de Neurología, Instituto de Neurociencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España.
C
C
Serna-Candel
Servicio de Diagnóstico por Imagen, Hospital Clínico San Carlos, Madrid, España.
J M
JM
Espejo-Domínguez
Servicio de Neurología, Instituto de Neurociencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España.
M
M
Fernández-Matarrubia
Servicio de Neurología, Instituto de Neurociencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España.
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P
Simal
Servicio de Neurología, Instituto de Neurociencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España.
J
J
Matias-Guiu
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography / Q000379:methods; D002536:Cerebral Arteries / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed / Q000379:methods
Angio-TC; CT-angiography; Diagnosis; Diagnóstico; Endovascular; Fibrinólisis; Ictus; Occlusion; Oclusión; Stroke; Thrombolysis