title: Safety of Computed Tomographic Angiography in the Evaluation of Patients With Acute Stroke: A Single-Center Experience.
abstract: Noncontrasted head computed tomography (NCHCT) has long been the standard of care for acute stroke imaging. New guidelines recommending advanced vascular imaging to identify eligible patients for endovascular therapy have renewed safety concerns on the use of contrast in the emergent setting without laboratory confirmation of renal function.
  
  
  
  We compared computed tomographic angiography (CTA) versus NCHCT alone during acute stroke evaluation with focus on renal safety and timeliness of therapy delivery. We reviewed data on all emergency department patients for whom the Acute Stroke Intervention Team was activated between December 2013 and September 2014. Primary outcomes included acute kidney injury and change in serum creatinine from presentation to 24 to 48 hours (Δ serum creatinine [Cr]). We assessed therapy delay using door-to-CT and door-to-needle times.
  
  
  
  Of 289 patients requiring Acute Stroke Intervention Team activation, 157 received CTA and 132 NCHCT only. There was no difference between groups in mean Cr at 24 to 48 hours (1.06 CTA; 1.40 NCHCT; P=0.059), ΔCr (-0.07 CTA, -0.11 NCHCT, P=0.489), or rates of acute kidney injury (5 CTA, 7 NCHCT, P=0.422). There was no significant difference in mean intravenous tissue plasminogen activator treatment times (68.11 minutes CTA, 81.36 minutes NCHCT; P=0.577). In the 157 patients who underwent CTA, 16 (10.2%) vascular anomalies and 55 (35.0%) high-grade stenoses or occlusions were identified.
  
  
  
  CTA acquisition during acute stroke evaluation was safe with regards to renal function and did not delay appropriate therapy delivery. Acute CTA acquisition offers additional clinical value in rapid identification of vascular abnormalities.
authors.affiliation: From the Department of Neurology, University of Virginia, Charlottesville (M.E.E., H.L.T., L.J.C., B.B.W., A.M.S.); and Department of Radiology, Stanford University, CA (M.W.). LAZ4U@hscmail.mcc.virginia.edu.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Ehrlich
authors.affiliation: From the Department of Neurology, University of Virginia, Charlottesville (M.E.E., H.L.T., L.J.C., B.B.W., A.M.S.); and Department of Radiology, Stanford University, CA (M.W.).
authors.forename: Heather L
authors.initials: HL
authors.lastname: Turner
authors.affiliation: From the Department of Neurology, University of Virginia, Charlottesville (M.E.E., H.L.T., L.J.C., B.B.W., A.M.S.); and Department of Radiology, Stanford University, CA (M.W.).
authors.forename: Lillian J
authors.initials: LJ
authors.lastname: Currie
authors.affiliation: From the Department of Neurology, University of Virginia, Charlottesville (M.E.E., H.L.T., L.J.C., B.B.W., A.M.S.); and Department of Radiology, Stanford University, CA (M.W.).
authors.forename: Max
authors.initials: M
authors.lastname: Wintermark
authors.affiliation: From the Department of Neurology, University of Virginia, Charlottesville (M.E.E., H.L.T., L.J.C., B.B.W., A.M.S.); and Department of Radiology, Stanford University, CA (M.W.).
authors.forename: Bradford B
authors.initials: BB
authors.lastname: Worrall
authors.affiliation: From the Department of Neurology, University of Virginia, Charlottesville (M.E.E., H.L.T., L.J.C., B.B.W., A.M.S.); and Department of Radiology, Stanford University, CA (M.W.).
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Southerland
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy; D002533:Cerebral Angiography / Q000009:adverse effects* / Q000379:methods; D000072226:Computed Tomography Angiography / Q000009:adverse effects* / Q000379:methods; D003404:Creatinine / Q000097:blood; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D003404:Creatinine; D010959:Tissue Plasminogen Activator
keywords: acute kidney injury; cerebrovascular disorders; quality assurance, health care; stroke; tissue-type plasminogen activator