Abstract
Background: AHA/ASA guidelines recommend obtaining early vessel imaging with CT angiography (CTA) or MR angiography (MRA) only in a select group of acute ischemic stroke (AIS) patients suspected to have large vessel occlusion (LVO). There is limited data on the utility of early cerebrovascular imaging in all suspected AIS patients presenting within 24 hours and its impact on door in-door out (DIDO) time. Methods: In January 2020, our Primary Stroke Center implemented a protocol to obtain upfront head and neck CTA simultaneously with a non contrast head CT for all suspected ischemic stroke patients screening positive for BE-FAST stroke symptoms within 24 hours from last known normal time. We retrospectively reviewed patients before (January 1-December 31, 2019) and after protocol implementation (January 1, 2020-June 30, 2022) to assess time metrics for patients receiving IV thrombolysis and/or transfer for thrombectomy. Results: A total of 86 AIS patients were evaluated during the study period. Time metrics before and after protocol implementation for thrombectomy eligible patients are shown in the figure. Compared to 2019, up-front CTA was associated with significant reductions in Door-to-CTA start (median 37 vs 14 minutes, p=0.05), Door-to-CTA interpretation (median 83 vs 52 minutes, p=0.02) and DIDO times (median 150 vs 106 minutes, p=0.02) in the final 12 months of the study period. There was no significant difference in door-to-needle time before and after protocol implementation (median 48 vs 43 minutes, p=0.40). Conclusion: In conclusion, up-front cerebrovascular imaging with CTA in suspected AIS patients presenting within 24 hours resulted in shorter DIDO times without delaying door-to-needle times. Primary Stroke Centers should consider this approach to detect LVO early and accelerate patient transport to thrombectomy capable centers.
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