CT Head — Stroke: Non-Thrombolysis / Thrombectomy
CTNICE NG1282019, updated 2022 (Replaces CG68)v2.0 · March 2026
Immediate
ED
All imaging requests must be justified by an IR(ME)R practitioner (radiologist or radiographer)Required Assessment Tools
REQUIRED
ROSIER
Recognition of Stroke in the Emergency Room — clinical assessment tool for suspected stroke
>0 = stroke suspected; ≤0 = stroke less likely (but not excluded — clinical judgement applies)
Immediate CT
Immediate— ANY of the following
- ROSIER score >0 (score ≤0 = stroke less likely but not excluded)NICE NG128
- GCS <13
- Progressive or fluctuating symptoms
- Papilloedema, neck stiffness, or fever
- Severe headache at onset
- Indication for early anticoagulation
- Potentially eligible for thrombectomy
Thrombectomy pathway
ImmediateCTA immediately following initial CT; imaging pathway depends on time from onset
- CTA immediately following initial CT
- Anterior circulation LVO <6 hours
- Up to 24 hours with CTP mismatch
- CTP when >6 hours from onset
Notes
Information
CTA immediately after NCCT if thrombectomy considered
Information
CTP required >6 hours from onset
Information
CG68 fully superseded — remove all references
NICE NG128Radiation Dose
CT head ~2 mSv; CTA head/neck ~3–5 mSv; CTP ~2–5 mSv
Guideline Corrections
CG68 → NG128 (2019, updated 2022)
CG68 fully superseded by NG128
Change Log
v1.02026-03-05Initial publication
v2.02026-03-08CG68 correction added. Thrombectomy 24-hour advanced imaging pathway confirmed.