Clinical Predictors of Large Vessel Occlusion and Diagnostic Accuracy of Non-Contrast CT in Acute Ischemic Stroke: A Cross-Sectional Study
DOI:
https://doi.org/10.66328/ijprmh.2026.020205Keywords:
Acute ischemic stroke, Large vessel occlusion, Computed tomography angiography, Hemiparesis, Endovascular thrombectomy, Diagnostic accuracyAbstract
Received: 20-06-2026
Revised: 27-06-2026
Accepted: 29-06-2026
Introduction: Large vessel occlusion (LVO) is a major determinant of morbidity and mortality in acute ischemic stroke (AIS), requiring rapid identification for timely reperfusion therapy. While computed tomography angiography (CTA) is the reference standard for detecting LVO, non-contrast computed tomography (NCCT) remains the most widely accessible imaging modality in many healthcare settings. This study evaluated clinical predictors of LVO and assessed the diagnostic performance of NCCT against CTA-confirmed occlusion.
Methods: A hospital-based cross-sectional study was conducted among 72 consecutive adults presenting with suspected AIS who underwent both NCCT and CTA. Demographic characteristics, clinical presentations, vascular risk factors, and imaging findings were analyzed. Multivariable logistic regression was used to identify independent predictors of LVO. Diagnostic accuracy parameters of NCCT were calculated using CTA as the reference standard.
Results: CTA confirmed LVO in 43 patients (59.7%). The middle cerebral artery was the most commonly affected vessel (69.8%). Hemiparesis showed a significant association with LVO (OR 2.89, 95% CI: 1.08–7.73; p=0.034) and remained the only independent predictor on multivariable analysis (adjusted OR 3.06, 95% CI: 1.09–8.61; p=0.034). NCCT demonstrated a sensitivity of 88.4%, specificity of 72.4%, positive predictive value of 82.6%, negative predictive value of 80.8%, and overall diagnostic accuracy of 81.9% for detecting CTA-confirmed LVO.
Conclusion: LVO was common among patients presenting with suspected AIS. Hemiparesis independently predicted the presence of LVO, while NCCT exhibited high sensitivity and satisfactory diagnostic accuracy. Integration of clinical assessment with NCCT findings may facilitate early triage and prompt referral for advanced stroke management, particularly in resource-limited settings.
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Copyright (c) 2026 Keepa Suryabanshi, Aakash Yousuf, Aaseem Anand (Author)
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