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Stroke Audit Finds Long CT-to-CTA Times
A regional UK audit found wide variation in imaging intervals among patients referred for mechanical thrombectomy and identified potentially modifiable barriers to timely vascular imaging.
To evaluate the intervals between computed tomography (CT) and computed tomography angiography (CTA) in patients with large-vessel occlusion stroke referred for mechanical thrombectomy.
Approach:
Study Design: A regional retrospective audit of 200 consecutive patients referred from 18 primary stroke centers to a London comprehensive stroke center between January 2022 and March 2023.
Patient Selection: 179 patients with acute large-vessel occlusion ischemic stroke were included after excluding 21 patients with missing timing data.
Primary Measure: The interval from CT to CTA at the referring hospital was measured, with operational definitions for 'excellent' and 'adequate' intervals established.
Data Analysis: Mean and median CT-to-CTA intervals were calculated, and hospital-level comparisons were made among centers referring more than eight patients.
Key Findings:
The mean CT-to-CTA interval at referring centers was 62 minutes, with a median of 55 minutes.
At the comprehensive stroke center, the mean and median intervals were 1 minute.
Approximately 55% of patients received CTA within 10 minutes; 45% had longer intervals, with 30% waiting at least 60 minutes.
One primary stroke center had a mean interval of 5 minutes or less, and four had a mean interval of 10 minutes or less.
Interpretation:
Limitations:
Retrospective design and small, uneven hospital samples.
Missing timing data and lack of adjustment for patient- and hospital-level factors.
Low survey response rate and failure to measure time to referral, transfer, groin puncture, reperfusion, or functional recovery.
