Vascular imaging (CTA/MRA)

Non-invasive computed tomography angiography (CTA) and magnetic resonance angiography (MRA) constitute an integral part of the diagnostic workup of stroke patients, which—among the various techniques to image the complex cerebrovascular tree—can be conceptually placed between duplex sonography and digital subtraction angiography. CTA and especially MRA can be performed with different techniques and protocols that need to be used according to the clinical questions. In the setting of acute ischaemic stroke with the therapeutic option of endovascular thrombectomy, the rapid and reliable detection of large vessel occlusion has become of paramount importance. Both CTA and MRA can accomplish this and there is no need for contrast material when performing intracranial MRA. Vascular imaging is also essential to identify vessel-related causes of stroke such as large artery atherosclerosis, dissection, and some forms of arteritis mandating specific management or therapeutic intervention to avoid recurrence. Considering these aspects, frequent and targeted use of CTA or MRA is highly encouraged and especially relevant in young patients with stroke.