Barcelona Study Shows Benefit of Immediate Angiography Versus CT Scan in Stroke Treatment

March 17, 2021—Immediate angiography, rather than the standard CT scan, reduced stroke treatment time and was linked to improved recovery in a study that enrolled 150 stroke patients admitted to Vall d’Hebron Hospital in Barcelona, Spain, from October 2018 to November 2020. The average age of the patients was 73 years, and more than half were male. The patients in the study were admitted to the hospital within 6 hours of stroke symptom onset with a suspected blocked blood vessel and were randomly assigned to receive angiography or a cardiac CT scan.

The study was a late-breaking science presentation at the American Stroke Association’s (ASA’s) International Stroke Conference 2021, held virtually March 17-19, 2021.

As summarized in the announcement from ASA, the interim analysis showed that stroke patients assigned to angiography underwent testing within 19 minutes of entering the hospital—less than half of the 43 minutes for the patients who received a CT scan. Similarly, stroke patients assigned to angiography received endovascular treatment to restore blood flow 54 minutes faster, on average, compared to CT scan recipients.

At 90 days poststroke, angiography patients were more likely than CT scan patients to show a one-point improvement on the six-point scale that measures stroke disability.

“Our study is the first clinical trial that shows the superiority of direct transfer to an angiography suite,” commented the lead study author, Manuel Requena, MD, in the ASA announcement. “Our findings were close to what we expected, and we were surprised that they occurred so early in the study. We trust that they will be confirmed in ongoing, multicenter, international trials.”

Dr. Requena, who is a neurologist and neurointerventionalist fellow at Vall d’Hebron Hospital, continued, “Stroke patients transferred directly to an angiography suite were less likely to be dependent for assistance with daily activities compared to the stroke patients who received the current standard of care—CT scan. More frequent and more rapid treatment can help improve outcomes for our stroke patients.”

A limitation of this study was the hospital already had extensive experience with immediate angiography, so findings may differ at hospitals or care centers with less angiography expertise or experience; also, the results of the study were not monitored by an external review group.

The announcement noted that many national and international professional organizations including the ASA have suggested general stroke recommendations based on the currently available evidence to monitor the time from emergency room arrival until blood flow is restored to the blocked brain artery in order to reduce the risk of severe disability and death. However, data demonstrating the urgent need for continued research on treatment of ischemic stroke are limited, advised the ASA.