268 Predicting large vessel occlusion using non-contrast CT brain in patients with acute stroke

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Introduction Detecting large vessel occlusion (LVO)is required to facilitate mechanical thrombectomy in stroke, but angiography is not always routinely available . Hyperdense vessel sign (HVS) and more recently conjugate eye deviation on CT brain have been associated with LVO. Eye deviation and HVS were examined by non-radiologists to determine predictive value for LVO. Methods Presence of radiological eye deviation and HVS were examined on brain CT for stroke patients with baseline CT angiography. Eye deviation and HVS were compared to angiographic status .Assess- ments were performed blinded to clinical information and angiographic status. Results From 195 cases 122 had large vessel occlusion. HVS sign predicted LVO with PPV of 90.7, specificity 89.2. Eye deviation predicted LVO with PPV 81.7, specificity 74.3. Presence of both HVS and radiologi- cal eye deviation strongly correlated with LVO ;PPV 98.3, specificity 98.6. Thirty cases with LVO had eye deviation without HVS indicating independent predictive value. Conclusion Eye deviation and HVS both show high specificity for LVO, particularly when detected in combination. They are rapidly and reliably detected by non-neuroradiologists on CT brain. Eye deviation on CT ± HVS should prompt consideration of thrombectomy even when angiographic imaging is not available given the likelihood of LVO.– ferghalmcverry@doctors.org.uk

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