Patient Outcomes With Use of Computed Tomography Angiography in Acute Ischemic Stroke and Transient Ischemic Attack: A Systematic Review and Meta-Analysis

Siying Shari Li; Aleksandar Trajkovski; Michael Siarkowski; Calvin Santiago; Kevin A Eng; Teruko Kishibe; Athithyan Umakanthan; Eddy Lang

doi:10.7759/cureus.8187

Patient Outcomes With Use of Computed Tomography Angiography in Acute Ischemic Stroke and Transient Ischemic Attack: A Systematic Review and Meta-Analysis

Cureus. 2020 May 18;12(5):e8187. doi: 10.7759/cureus.8187.

Authors

Siying Shari Li¹, Aleksandar Trajkovski², Michael Siarkowski^{3

4}, Calvin Santiago⁵, Kevin A Eng⁶, Teruko Kishibe⁷, Athithyan Umakanthan⁸, Eddy Lang⁹

Affiliations

¹ Emergency Medicine, University of British Columbia, Vancouver, CAN.
² Family Medicine, Dalhousie University, Halifax, CAN.
³ Biomedical Technology, University of Calgary, Calgary, CAN.
⁴ Dentistry, University of British Columbia, Vancouver, CAN.
⁵ Neurology, University of Toronto, Toronto, CAN.
⁶ Radiology, Western University, London, CAN.
⁷ Scotiabank Health Sciences Library, St Michael's Hospital, Toronto, CAN.
⁸ Epidemiology and Public Health, Schulich School of Medicine & Dentistry, Western University, London, CAN.
⁹ Emergency Medicine, University of Calgary, Calgary, CAN.

Abstract

Objectives It remains uncertain whether computed tomography angiography (CTA) in ischemic strokes and transient ischemic attacks (TIAs) benefits patient outcomes beyond those eligible for endovascular therapy. We conducted a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs) investigating the use of CTA against other imaging modalities for recurrent stroke, mortality, disability, emergency department (ED) revisits, or changes in management in ischemic stroke and TIA. (PROSPERO: 349590) Methods MEDLINE, Embase, and CENTRAL were searched. We included studies evaluating CTA against non-CTA imaging modalities for outcomes of interest in ischemic stroke or TIA. Two reviewers extracted data and assessed study quality. Data were pooled by the generic inverse variance method. Heterogeneity was assessed using Cochran's Q statistic and quantified by I². Quality of the evidence was assessed by GRADE. Results We found 12 eligible cohort studies involving 17,481 patients, and no eligible RCTs. No changes were detected in recurrent stroke, mortality, or disability when CTA was compared against pooled imaging modalities, nor compared to non-contrast computed tomography (NCCT) alone. The evidence for each outcome was graded as low quality to very low quality. Conclusions CTA use was not associated with significant reductions in recurrent stroke, mortality, or disability in ischemic stroke and TIA patient compared with other imaging modalities. More high-quality studies are needed.

Keywords: computed tomography angiography; ct angiography; cta; ischemic stroke; stroke; tia; transient ischemic attack.

Grants and funding

Research reported in this publication was s1upported in part by the Alberta Health Services Emergency Strategic Clinical Network (ESCN). The content is solely the responsibility of the authors and does not necessarily represent the official views of the ESCN Scientific Office or Alberta Health Services.