Can a patient with a recent stroke and potential osteoporosis undergo a Computed Tomography Angiography (CTA)?

Can This Patient Get a CTA?

Yes, a patient with recent stroke and potential osteoporosis can and should undergo CTA if clinically indicated for stroke evaluation—osteoporosis is not a contraindication to CTA. 1

Why CTA is Recommended in Stroke Patients

CTA from aortic arch to vertex is a critical component of acute stroke evaluation and should be performed without delay in appropriate patients, regardless of osteoporosis status. 1

Immediate CTA Indications

For patients presenting within 6 hours of symptom onset who are potentially eligible for endovascular thrombectomy (EVT), immediate CTA from arch-to-vertex is essential to identify large vessel occlusions. 1 This imaging should include both extra- and intracranial circulation and must not be delayed. 1

• CTA should be performed at the time of initial brain CT to rapidly assess for large vessel occlusion and guide mechanical thrombectomy decisions 1, 2
• The sensitivity and specificity of CTA for detecting intracranial occlusions ranges between 92-100% and 82-100%, respectively 1
• CTA provides crucial information for endovascular procedural planning by imaging extracranial carotid and vertebral arteries in addition to intracranial circulation 1

CTA for Secondary Prevention

For patients with TIA or non-disabling stroke, noninvasive vascular imaging including CTA is recommended to identify symptomatic carotid stenosis that may require revascularization. 1

• Initial CTA is the most cost-effective strategy for patients at high risk of carotid artery stenosis who can undergo surgery without delay 1
• CTA should be completed within timeframes based on stroke risk stratification: within 24 hours for high-risk patients with motor weakness or speech disturbance 1

Osteoporosis is NOT a Contraindication

There are no contraindications to CTA related to osteoporosis. The primary concerns with CTA are:

• Renal function: For patients who otherwise meet criteria for EVT, it is reasonable to proceed with CTA before obtaining serum creatinine in patients without a history of renal impairment 1
• Contrast allergy: Not mentioned as a concern in your patient
• Pregnancy: Not applicable here

The Osteoporosis-Stroke Connection

While osteoporosis is a recognized complication of stroke (affecting up to 36.7% of acute stroke patients), it does not impact the decision to perform CTA. 3, 4

• Post-stroke osteoporosis develops due to paresis, reduced mobility, and decreased bone load—not as a pre-existing condition that would contraindicate imaging 5
• The concern with osteoporosis in stroke patients relates to fracture risk during rehabilitation, not imaging contraindications 3, 6

When CTA Should Not Delay Treatment

Multimodal CT including CTA should not delay administration of IV alteplase if indicated. 1 However, this does not mean CTA should be skipped—it means the workflow should be optimized:

• For patients within 4.5 hours eligible for thrombolysis: perform non-contrast CT immediately, give alteplase if appropriate, then proceed with CTA 1
• For patients within 6 hours potentially eligible for EVT: perform both non-contrast CT and CTA together without delay 1

Common Pitfalls to Avoid

• Do not skip vascular imaging when clinical suspicion for stroke remains high, as CTA may reveal vessel occlusions even when parenchymal changes aren't yet visible on CT 7
• Do not delay CTA to obtain renal function tests in patients without known renal impairment who are potential EVT candidates 1
• Do not confuse osteoporosis concerns with actual CTA contraindications—the radiation exposure and contrast administration are not contraindicated by bone disease 1