Computed tomography angiography versus computed tomography for the diagnosis and management of hyperacute stroke a review of comparative clinical evidence and guidelines
It is an invasive procedure and may not readily be available for critically ill patients, and it has other limitations including being an expensive and resource-intensive procedure, as well as being associated with 0.9% and 0.5% risk of transient and permanent neurologic deficits, respectively. Comp...
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| Format: | eBook |
| Language: | English |
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Ottawa (ON)
Canadian Agency for Drugs and Technologies in Health
10 December 2013, 2013
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| Series: | Rapid response report: summary with critical appraisal
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| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | It is an invasive procedure and may not readily be available for critically ill patients, and it has other limitations including being an expensive and resource-intensive procedure, as well as being associated with 0.9% and 0.5% risk of transient and permanent neurologic deficits, respectively. Computed tomography angiography (CTA) provides a low risk, lower cost, and readily accessible alternative to DSA to detect underlying structural vascular abnormality in a non-invasive way and to predict the risk of hematoma growth and guides the use of hemostatic drugs. However, CTA cannot clearly display blood stream and blood supply for vascular abnormalities. Imaging modalities such as CT and computed tomography angiography (CTA) provide caregivers access to knowledge about the presence of hemorrhage or an intravascular thrombus that can be treated with thrombolysis or thrombectomy. Imaging also allows the detection and estimation of the size of a core of irreversibly infarcted tissue and/or hypoperfused tissue at risk for subsequent infarction unless adequate perfusion is restored. Such information guides treatment decisions such as selection of patients, based on the merit of each case, for best available intervention to ensure optimal care and better patient outcomes in a timely manner. This report aims to provide evidenced-based comparative information to facilitate decision making on the use of the CT and/or CTA imaging modalities for the diagnosis and management of hyperacute stroke Hemorrhagic stroke may be caused by primary or secondary intracranial hemorrhage (ICH), Primary ICH is often associated with hypertension or cerebral amyloid angiopathy (CAA); and secondary ICH may be caused by aneurysms, anticoagulation, or hemorrhage due to neoplasm, infarction, or sinus thrombosis. Hyperacute stroke interventions include intensive care unit admission, blood pressure control, correction of coagulopathy, and neurosurgical consultation. Though non-enhanced CT is a widely used screening technique in distinguishing ischemic from hemorrhagic acute stroke, it is not very sensitive at determining the underlying structural vascular abnormality in hemorrhagic stroke, which is critical for instituting the appropriate treatment. The reference standard for diagnosing vascular lesions is digital subtraction angiography (DSA). |
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| Item Description: | Title from PDF caption. - "CADTH rapid response service." |
| Physical Description: | 1 PDF file (19 pages) |