A quantitative analysis of CT angiography, large vessel occlusion, and thrombectomy rates in acute ischaemic stroke

AIMS To determine the workload of acute computed tomography angiography (CTA) in patients presenting with suspected acute ischaemic stroke (AIS) and rate of large vessel occlusion (LVO) and thrombectomy relative to suspected and confirmed stroke diagnoses across three stroke centres within the Republic of Ireland. MATERIALS AND METHODS A retrospective review of data from three stroke centres, one of which provides a 24-hour thrombectomy service was undertaken. The number of CTA studies performed from January 2015 to December 2017 for suspected AIS was quantified using the national PACS in addition to occlusion location, collateral status, and rates of LVO and thrombectomy. The hospital inpatient enquiry (HIPE) system was searched for all patients with a primary discharge diagnosis of stroke and then correlated with patients who underwent CTA on admission. RESULTS A total of 2,358 CTA studies were performed for suspected AIS during the study period across three stroke centres. LVO was demonstrated in 18.4% of suspected AIS, 18.4% of primary discharge stroke diagnoses, and 40.2% of confirmed AIS who underwent CTA. A total of 283 thrombectomies were performed of which 64.6% were LVO. Thrombectomy was performed in 12% of suspected AIS, 12% of overall primary discharge diagnoses of stroke cases, and 26% of confirmed stroke who underwent CTA. CONCLUSION Establishing the volume of acute CTAs and rates of LVO and thrombectomy when compared to suspected AIS on admission, confirmed stroke diagnoses who underwent CTA and primary discharge diagnosis of stroke is essential for the planning and provision of stroke services worldwide.