title: Site and Rate of Occlusive Disease in Cervicocerebral Arteries: A CT Angiography Study of 2209 Patients with Acute Ischemic Stroke.
abstract: OBJECTIVE
  CTA can rapidly and accurately detect and localize occlusive disease in patients with ischemic stroke. We have used CTA to assess arterial stenosis and occlusion in an ischemic stroke population arriving at a tertiary stroke center within 24 hours of symptom onset in order to obtain a comprehensive picture of occlusive disease pattern, and to determine the proportion of eligible candidates for endovascular treatment.
  
  
  METHODS
  Data from consecutive patients with acute ischemic stroke admitted to a single center between 2003 and 2012, collected in the Acute Stroke Registry and Analysis of Lausanne data base, were retrospectively analyzed. Patients with a diagnostic CTA within 24 hours of symptom onset were selected. Relevant extra- and intracranial pathology, defined as stenosis of ≥50% and occlusions, were registered and classified into 21 prespecified segments.
  
  
  RESULTS
  Of the 2209 included patients (42.1% women; median age, 72 years), 1075 (48.7%) had pathology in and 308 (13.9%) had pathology outside the ischemic territory. In the 50,807 arterial segments available for revision, 1851 (3.6%) abnormal segments were in the ischemic (symptomatic) territory and another 408 (0.8%) were outside it (asymptomatic). In the 1211 patients with ischemic stroke imaged within 6 hours of symptom onset, 40.7% had symptomatic large, proximal occlusions potentially amenable to endovascular therapy.
  
  
  CONCLUSIONS
  CTA in patients with acute ischemic stroke shows large individual variations of occlusion sites and degrees. Approximately half of such patients have no visible occlusive disease, and 40% imaged within 6 hours show large, proximal segment occlusions amenable to endovascular therapy. These findings show the importance of early noninvasive imaging of extra- and intracranial arteries for identifying occlusive disease, planning recanalization strategies, and designing interventional trials.
authors.affiliation: From the Department of Diagnostic and Interventional Radiology (D.C.R., P.J.M., R.A.M., P. Maeder) david.rotzinger@chuv.ch.
authors.forename: D C
authors.identifier: http://orcid.org/0000-0002-6321-3180
authors.initials: DC
authors.lastname: Rotzinger
authors.affiliation: From the Department of Diagnostic and Interventional Radiology (D.C.R., P.J.M., R.A.M., P. Maeder).
authors.forename: P J
authors.identifier: http://orcid.org/0000-0001-5111-1972
authors.initials: PJ
authors.lastname: Mosimann
authors.affiliation: From the Department of Diagnostic and Interventional Radiology (D.C.R., P.J.M., R.A.M., P. Maeder).
authors.forename: R A
authors.identifier: http://orcid.org/0000-0002-9573-3076
authors.initials: RA
authors.lastname: Meuli
authors.affiliation: From the Department of Diagnostic and Interventional Radiology (D.C.R., P.J.M., R.A.M., P. Maeder).
authors.forename: P
authors.identifier: http://orcid.org/0000-0002-2875-4889
authors.initials: P
authors.lastname: Maeder
authors.affiliation: Neurology Service (P. Michel), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: P
authors.identifier: http://orcid.org/0000-0003-4954-7579
authors.initials: P
authors.lastname: Michel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging*; D000072226:Computed Tomography Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000000981:diagnostic imaging*