title: Value of CT angiography in anterior circulation large vessel occlusive stroke: Imaging findings, pearls, and pitfalls.
abstract: Hyperacute stroke imaging is playing an increasingly important role in determining management decisions in acute stroke patients, particularly patients with large vessel occlusive stroke who may benefit from endovascular intervention. CT angiography (CTA) is an important tool in the work-up of the acute stroke patient. It reliably detects large occlusive thrombi in proximal cerebral arteries and is a quick and highly accurate method in identifying candidates for endovascular stroke treatment. In this article we review the imaging findings on CTA in acute large vessel occlusive stroke using a pictorial case based approach. We retrospectively reviewed CTA studies in 48 patients presenting with acute anterior circulation large vessel occlusive stroke who were brought for intra-arterial acute stroke intervention. We discuss and illustrate patterns of proximal intracranial arterial occlusion, collateralization to the occluded territory, as well as reviewing some important pearls, pitfalls and teaching points in CTA assessment of the acute stroke patient. Performed from the level of the aortic arch CTA also gives valuable information regarding the state of other vessels in the acute stroke patient, identifying additional significant vascular stenoses or occlusions, and as we illustrate, can demonstrate other clinically significant findings which may impact on patient management and outcome.
authors.affiliation: Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9, Ireland. Electronic address: drsarahpower@gmail.com.
authors.forename: Sarah
authors.initials: S
authors.lastname: Power
authors.affiliation: Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9, Ireland. Electronic address: sineadmcevoy@beaumont.ie.
authors.forename: Sinead H
authors.initials: SH
authors.lastname: McEvoy
authors.affiliation: Department of Radiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9, Ireland. Electronic address: janecunningham0708@gmail.com.
authors.forename: Jane
authors.initials: J
authors.lastname: Cunningham
authors.affiliation: Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9, Ireland. Electronic address: joannapearlyti@gmail.com.
authors.forename: Joanna P
authors.initials: JP
authors.lastname: Ti
authors.affiliation: Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9, Ireland. Electronic address: seamuslooby@beaumont.ie.
authors.forename: Seamus
authors.initials: S
authors.lastname: Looby
authors.affiliation: Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9, Ireland. Electronic address: alanohare@beaumont.ie.
authors.forename: Alan
authors.initials: A
authors.lastname: O'Hare
authors.affiliation: Department of Geriatrics, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9, Ireland. Electronic address: davidwilliams@rcsi.ie.
authors.forename: David
authors.initials: D
authors.lastname: Williams
authors.affiliation: Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9, Ireland. Electronic address: paulbrennan@beaumont.ie.
authors.forename: Paul
authors.initials: P
authors.lastname: Brennan
authors.affiliation: Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9, Ireland. Electronic address: johnthornton@beaumont.ie.
authors.forename: John
authors.initials: J
authors.lastname: Thornton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging*; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D002536:Cerebral Arteries / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007472:Iohexol; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011856:Radiographic Image Enhancement; D020521:Stroke / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D007472:Iohexol
keywords: CT angiography; Collateral score; Mechanical thrombectomy; Outcome; Stroke