ArticleThe British journal of radiology2026
CT-to-CT angiography time-an easy target for acute stroke pathway improvement: a retrospective analysis of time from CT to CT angiography in thrombectomy for ischemic stroke.
Article in The British journal of radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo assess CT-to-CT angiography (CT-CTA) times at primary stroke centers (PSCs) for patients eligible for mechanical thrombectomy (MT) in acute ischemic stroke and to identify causes of imaging delays.
methodsThis retrospective study analyzed CT-CTA intervals in 200 consecutive patients referred from 18 PSCs in South-East England to a comprehensive stroke center (CSC) (January 2022-March 2023). Times were benchmarked (≤5 min = excellent, ≤10 min = adequate). Inclusion/exclusion following MT guidelines. Confounding variables were analyzed using Welch's t-test and one-way ANOVA. A qualitative survey explored delay causes.
resultsThe mean CT-CTA time at PSCs was 62 min (SD 21), vs 1 min (SD 1) at the CSC (P < .00001, Hedges' g = 3). Only 9% of PSCs achieved excellent, and 36% adequate, CT-CTA times. No significant differences were found based on time of day, thrombolysis, or NIHSS. However, wide variation existed between PSCs. Survey findings cited technical (eg, lack of CT perfusion, out-of-hours reporting), organizational (eg, scanner access, lack of stroke specialists), and educational (eg, unawareness or dismissal of guidelines) barriers.
conclusionsCT-CTA delays at PSCs impede timely MT referrals. Improvements in training, infrastructure, and policy (eg, revised SSNAP metrics) are needed for optimizing stroke care pathways. ADVANCES IN KNOWLEDGE: This study is the first to systematically assess CT-CTA time adherence across PSCs, and it reveals substantial delays and modifiable barriers. It provides actionable insights for optimizing stroke imaging protocols, reinforcing the need for integrated workflows to enhance MT accessibility and outcomes.
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