ISC 2026 | The rationale for performing CT angiography in all cases of intracerebral hemorrhage
Umberto Pensato, MD, Humanitas University, Milan, Italy, discusses the rationale for performing CT angiography in all cases of intracerebral hemorrhage. Dr Pensato emphasizes its value in identifying secondary causes, improving prognostication, and predicting hematoma expansion while remaining safe, feasible, and economically justified in acute care settings. This interview took place at the 2026 International Stroke Congress (ISC), held in New Orleans, LA.
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Transcript
We made the argument for a CTA for all ICH cases based on some major domains that should be considered. So first of all, CTA helps for the secondary etiology identification. And so we might be able to promptly start appropriate treatment for patients with secondary ICH, for example, due to aneurysm rupture or due to cerebral venous thrombosis. Second point is that CTA improves the prognostication for the spot sign...
We made the argument for a CTA for all ICH cases based on some major domains that should be considered. So first of all, CTA helps for the secondary etiology identification. And so we might be able to promptly start appropriate treatment for patients with secondary ICH, for example, due to aneurysm rupture or due to cerebral venous thrombosis. Second point is that CTA improves the prognostication for the spot sign. The third point is that it improves a lot the prediction of hematoma expansion. That is our main target, therapeutic target in the hyperacute phase. And when we think of possible downsides, we analyzed also the economic justification of CTA and this implementability. And the implementation is quite straightforward, especially if you consider that whenever a patient is assessed in the acute phase, the patient is already going through a CTA or CTP. So in order to perform CTA, even though there is no ischemic stroke, but a hemorrhagic stroke, you just should go on with the internal protocol. And from a safety standpoint, we also show that it’s very safe. The risks are very minimal. So we argue for a CTA for all ICH approach and denying CTA would reflect the same mindset of therapeutic nihilism that used to be applied in the past in this population. And we kind of call it diagnostic nihilism whenever we deny and withhold simple imaging analysis such as CTA in these patients.
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