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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.

Interactive Decision Tree

Mini Map

Algorithm Steps

  1. ▶
    Start

    Acute Stroke Symptoms

    Sudden focal neurological deficit

    1. ●
      Action

      Non-Contrast CT Head

      Door-to-CT <25 min target

      1. ◆
        Decision

        Hemorrhage on CT?

        1. ■
          End

          ICH Protocol

          BP control, reversal, neurosurgery

        2. ◆
          Decision

          Time from Last Known Well?

          • <4.5h
          • 4.5-24h
          • >24h
          1. ●
            Action

            tPA Eligibility

            Give tPA without waiting for CTA

            1. ●
              Action

              CTA ± CTP

              LVO detection + perfusion mismatch

              1. ◆
                Decision

                Large Vessel Occlusion?

                1. ■
                  End

                  Thrombectomy Candidate

                  ASPECTS ≥6, favorable mismatch

                2. ■
                  End

                  Medical Management

                  Antiplatelet, statin, admit stroke unit

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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