Background

Computed tomography (CT) angiogram protocols for patients who may require urgent neuro-intervention should be standardized across institutions to reduce the need for repeat studies and prevent delays in treatment.

Objective

We undertake a quality improvement project to identify CT angiogram protocols undertaken for acute procedures across a number of peripheral hospitals who refer to our centre for neuro-interventional care.

Methods

All patients who underwent an acute neuro-interventional procedure in the period between 1st January 2022 and 31st March 2022 were identified. All patients who had a procedure for acute ischemia (i.e. thrombectomy or similar) or acute treatment of intracranial aneurysm were included in the study. All imaging prior to the procedure were assessed for CTA protocol used to ensure appropriateness of investigation. Clinical end points for the study included CTA protocol used and if repeat CT imaging was required prior to the procedure. Further endpoints included comparison number of aneurysms identified per protocol used which was compared to rate of aneurysm identification on subsequent digital subtraction angiography.

Results

The results were used to produce an educational poster and furthermore are to be disseminated at the regional registrar on-call meeting with educational examples of the differences in protocols used and benefits/limitations of each.

Conclusions

In the context of acute non-traumatic intracranial haemorrhage where an underlying vascular malformation is suspected, including aneurysm, patients should undergo dedicated intracranial CTA only. In contrast, patients who undergo CT angiogram for acute ischaemic event, to assess for medium or large vessel occlusion, should have an protocol which includes the aortic arch to cerebral vertex to assess the craniocervical vasculature and identify intra-luminal filling defects.