title: Multimodal CT Imaging: Time to Treatment and Outcomes in the IMS III Trial.
abstract: The importance of time in acute stroke is well-established. Using the Interventional Management of Stroke III trial data, we explored the effect of multimodal imaging (CT perfusion and/or CT angiography) versus noncontrast CT alone on time to treatment and outcomes.
  
  
  
  We examined 3 groups: 1) subjects with baseline CTP and CTA (CTP+CTA), 2) subjects with baseline CTA without CTP (CTA), and 3) subjects with noncontrast head CT alone. The demographics, treatment time intervals, and clinical outcomes in these groups were studied.
  
  
  
  Of 656 subjects enrolled in the Interventional Management of Stroke III trial, 90 (13.7%) received CTP and CTA, 216 (32.9%) received CTA (without CTP), and 342 (52.1%) received NCCT alone. Median times for the CTP+CTA, CTA, and NCCT groups were as follows: stroke onset to IV tPA (120.5 versus 117.5 versus 120 minutes; P = .5762), IV tPA to groin puncture (77.5 versus 81 versus 91 minutes; P = .0043), groin puncture to endovascular therapy start (30 versus 38 versus 44 minutes; P = .0001), and endovascular therapy start to end (63 versus 46 versus 74 minutes; P < .0001). Compared with NCCT, the CTA group had better outcomes in the endovascular arm (OR, 2.12; 95% CI, 1.36-3.31; adjusted for age, NIHSS score, and time from onset to IV tPA). The CTP+CTA group did not have better outcomes compared with the NCCT group.
  
  
  
  Use of CTA with or without CTP did not delay IV tPA or endovascular therapy compared with NCCT in the Interventional Management of Stroke III trial.
authors.affiliation: From the Department of Radiology (A.V., A.L., J.S., T.A.T.), University of Cincinnati Medical Center, Cincinnati, Ohio Achala.Vagal@uchealth.com.
authors.forename: A
authors.identifier: 0000-0001-6428-6499
authors.initials: A
authors.lastname: Vagal
authors.affiliation: Department of Public Health Sciences (L.D.F., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina.
authors.forename: L D
authors.identifier: 0000-0001-6856-5583
authors.initials: LD
authors.lastname: Foster
authors.affiliation: Radiology (B.M, E.Q., M.G.), University of Calgary, Calgary Alberta, Canada.
authors.forename: B
authors.identifier: 0000-0002-3466-496X
authors.initials: B
authors.lastname: Menon
authors.affiliation: From the Department of Radiology (A.V., A.L., J.S., T.A.T.), University of Cincinnati Medical Center, Cincinnati, Ohio.
authors.forename: A
authors.identifier: 0000-0003-1841-9021
authors.initials: A
authors.lastname: Livorine
authors.affiliation: From the Department of Radiology (A.V., A.L., J.S., T.A.T.), University of Cincinnati Medical Center, Cincinnati, Ohio.
authors.forename: J
authors.identifier: 0000-0002-8895-5447
authors.initials: J
authors.lastname: Shi
authors.affiliation: Radiology (B.M, E.Q., M.G.), University of Calgary, Calgary Alberta, Canada.
authors.forename: E
authors.identifier: 0000-0003-0222-3884
authors.initials: E
authors.lastname: Qazi
authors.affiliation: Department of Public Health Sciences (L.D.F., S.D.Y.), Medical University of South Carolina, Charleston, South Carolina.
authors.forename: S D
authors.identifier: 0000-0001-9235-0670
authors.initials: SD
authors.lastname: Yeatts
authors.affiliation: Departments of Neurology (A.M.D., M.D.H.).
authors.forename: A M
authors.identifier: 0000-0002-4930-7789
authors.initials: AM
authors.lastname: Demchuk
authors.affiliation: Departments of Neurology (A.M.D., M.D.H.).
authors.forename: M D
authors.identifier: 0000-0002-6269-1543
authors.initials: MD
authors.lastname: Hill
authors.affiliation: From the Department of Radiology (A.V., A.L., J.S., T.A.T.), University of Cincinnati Medical Center, Cincinnati, Ohio.
authors.forename: T A
authors.identifier: 0000-0002-8053-1551
authors.initials: TA
authors.lastname: Tomsick
authors.affiliation: Radiology (B.M, E.Q., M.G.), University of Calgary, Calgary Alberta, Canada.
authors.forename: M
authors.identifier: 0000-0001-9060-2109
authors.initials: M
authors.lastname: Goyal
mesh_terms: D000368:Aged; D002533:Cerebral Angiography / Q000379:methods; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D020521:Stroke / Q000000981:diagnostic imaging* / Q000628:therapy*; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator