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 Ischaemic Stroke.
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Sarnecki T.
MancusoMarcello M.
Nikola C.
Spooner O.
Bhogal, P.
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2026
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OBJECTIVES: To assess CT-to-CT angiography (CT-CTA) times at primary stroke centres (PSCs) for patients eligible for mechanical thrombectomy (MT) in acute ischaemic stroke, and to identify causes of imaging delays. METHOD(S): This retrospective study analysed CT-CTA intervals in 200 consecutive patients referred from 18 PSCs in South-East England to a comprehensive stroke centre (CSC) (Jan 2022 - Mar 2023). Times were benchmarked (<=5 min = excellent, <=10 min = adequate). Inclusion/exclusion following MT guidelines. Confounding variables were analysed using Welch's t-test and one-way ANOVA. A qualitative survey explored delay causes. RESULT(S): The mean CT-CTA time at PSCs was 62 minutes (SD 21), versus 1 minute (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 (e.g., lack of CT perfusion, out-of-hours reporting), organisational (e.g., scanner access, lack of stroke specialists), and educational (e.g., unawareness or dismissal of guidelines) barriers. CONCLUSION(S): CT-CTA delays at PSCs impede timely MT referrals. Improvements in training, infrastructure, and policy (e.g., revised SSNAP metrics) are needed for optimising 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 optimising stroke imaging protocols, reinforcing the need for integrated workflows to enhance MT accessibility and outcomes. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the British Institute of Radiology.
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The British journal of radiology