title: Increasing use of computed tomographic perfusion and computed tomographic angiograms in acute ischemic stroke from 2006 to 2010.
abstract: OBJECTIVE
  Our objective was to study nationwide utilization trends of computed tomographic (CT) angiogram (CTA) and CT perfusion (CTP) in acute ischemic stroke and particularly in the context of use of reperfusion therapies.
  
  
  METHODS
  We reviewed the Premier Perspective Database for ischemic stroke-related hospitalizations of adult patients during a 5-year period, 2006 to 2010. Use of multimodal CT-based imaging and reperfusion therapies was determined through the procedure and billing codes. Logistic regression was used to identify predictors of utilization of imaging studies and reperfusion treatments.
  
  
  RESULTS
  An increasing proportion of ischemic strokes received CTA each year: 3.8% in 2006, 5.6% in 2007, 6.5% in 2008, 7.5% in 2009, and 9.1% in 2010 (P<0.0001). The proportion of acute strokes that were imaged with CTP imaging also increased each year: 0.05% in 2006, 0.05% in 2007, 0.9% in 2008, 2.2% in 2009, and 2.9% in 2010 (P<0.0001). Reperfusion treatment was more common among those who were imaged with CTA (13.0%) and CTP (17.6%) compared with those with CT head alone (4.0%; P<0.0001). Specifically, higher rates of recombinant tissue-type plasminogen activator were observed in CTA (10.2%) and CTP (11.4%) compared with those with CT head alone (3.8%; P<0.0001). Similarly, higher rates of mechanical embolectomy were observed in CTA (2.8%) and CTP (6.3%) compared with those with CT head alone (0.2%; P<0.0001).
  
  
  CONCLUSIONS
  There was a marked increase in the rate of CTA and CTP studies in setting of acute ischemic stroke from 2006 to 2010, and both modalities were associated with increased reperfusion therapy use.
authors.affiliation: From the Departments of Radiology (A.V.), Neurology (D.O.K., R.H., P.K.), Emergency Medicine (O.A.), and Family Medicine (K.M.), University of Cincinnati Medical Center, OH.
authors.forename: Achala
authors.initials: A
authors.lastname: Vagal
authors.forename: Karthikeyan
authors.initials: K
authors.lastname: Meganathan
authors.forename: Dawn O
authors.initials: DO
authors.lastname: Kleindorfer
authors.forename: Opeolu
authors.initials: O
authors.lastname: Adeoye
authors.forename: Richard
authors.initials: R
authors.lastname: Hornung
authors.forename: Pooja
authors.initials: P
authors.lastname: Khatri
mesh_terms: D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000188:drug therapy; D002533:Cerebral Angiography / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006780:Hospitals, Rural / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D055420:Perfusion Imaging / Q000706:statistics & numerical data*; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014481:United States
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: perfusion imaging; reperfusion; utilization