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Acute Stroke Imaging Protocol (AHA/ASA)

Acute Stroke Imaging Protocol (AHA/ASA): Acute Stroke Symptoms → Non-Contrast CT Head → Hemorrhage on CT? → ICH Protocol.

Pathway Overview

10 steps

Algorithm Steps

10 total

  1. 01Start

    Acute Stroke Symptoms

    Sudden focal neurological deficit

  2. 02Action

    Non-Contrast CT Head

    Door-to-CT <25 min target

  3. 03Decision

    Hemorrhage on CT?

  4. 04End

    ICH Protocol

    BP control, reversal, neurosurgery

  5. 05Decision

    Time from Last Known Well?

    • <4.5h
    • 4.5-24h
    • >24h
  6. 06Action

    tPA Eligibility

    Give tPA without waiting for CTA

  7. 07Action

    CTA ± CTP

    LVO detection + perfusion mismatch

  8. 08Decision

    Large Vessel Occlusion?

  9. 09End

    Thrombectomy Candidate

    ASPECTS ≥6, favorable mismatch

  10. 10End

    Medical Management

    Antiplatelet, statin, admit stroke unit

  11. Path rejoins step 07Shared downstream outcome

Guideline Source

AHA/ASA 2019 Guidelines for Early Management of Acute Ischemic Stroke

DOI: 10.1161/STR.0000000000000211View Guideline

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • CTP protocols vary by institution
  • Extended window criteria evolving (DAWN, DEFUSE-3)
  • MRI not always available emergently

Applicable Regions

USAUUKEU

EU: ESO guidelines; tenecteplase increasingly used

US: AHA/ASA guidelines standard

Version 1Next review: 2028-01-01

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Frequently Asked Questions

What is the Acute Stroke Imaging Protocol (AHA/ASA)?

The Acute Stroke Imaging Protocol (AHA/ASA) is a diagnostic clinical algorithm for Radiology. It provides a structured decision tree to guide clinical decision-making, based on AHA/ASA 2019 Guidelines for Early Management of Acute Ischemic Stroke.

What guideline is the Acute Stroke Imaging Protocol (AHA/ASA) based on?

This algorithm is based on AHA/ASA 2019 Guidelines for Early Management of Acute Ischemic Stroke (DOI: 10.1161/STR.0000000000000211).

What are the limitations of the Acute Stroke Imaging Protocol (AHA/ASA)?

Known limitations include: CTP protocols vary by institution; Extended window criteria evolving (DAWN, DEFUSE-3); MRI not always available emergently. Individual patient factors may require deviation from these recommendations.

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