Abstract
Background and purpose: Rapid thrombectomy for acute ischemic stroke caused by large vessel occlusion leads to improved outcome. Optimizing intrahospital management might diminish treatment delays. To examine if one-stop management reduces intrahospital treatment delays and improves functional outcome of acute stroke patients with large vessel occlusion. Methods: We performed a single center, observational study from June 2016 to November 2018. Imaging was acquired with the latest generation angiography suite at a comprehensive stroke center. Two-hundred-thirty consecutive adults with suspected acute stroke presenting within 6 h after symptom onset with a moderate to severe National Institutes of Health Stroke Scale (≥10 in 2016; ≥7 since January 2017) were directly transported to the angiography suite by bypassing multidetector CT. Noncontrast flat-detector CT and biphasic flat-detector CT angiography were acquired with an angiography system. In case of a large vessel occlusion patients remained in the angiography suite, received intravenous rtPA therapy and underwent thrombectomy. As primary endpoints, door-to-reperfusion times and functional outcome at 90 days were recorded and compared in a case-control analysis with matched prior patients receiving standard management. Results: A total of 230 patients (123 women, median age of 78 years (Interquartile Range (IQR) 69–84)) were included. Median symptom-to-door time was 130 min (IQR 70–195). Large vessel occlusion was diagnosed in 166/230 (72%) patients; 64/230 (28%) had conditions not suitable for thrombectomy. Median door-to-reperfusion time for M1 occlusions was 64 min (IQR 56–87). Compared to 43 case-matched patients triaged with multidetector CT, median door-to-reperfusion time was reduced from 102 (IQR 85–117) to 68 min (IQR 53–89; p < 0.001). Rate of good functional outcome was significantly better in the one-stop management group (p = 0.029). Safety parameters (mortality, sICH, any hemorrhage) did not differ significantly between groups. Conclusions: One-stop management for stroke triage reduces intrahospital time delays in our specific hospital setting.
Highlights
Swift and complete reperfusion of the occluded vessel territory is the key of every revascularization therapy in stroke patients with large vessel occlusion (LVO) [1,2]
Thrombectomy became the new standard of LVO-therapy after publication of multiple trials showing higher reperfusion rates and improved functional outcomes in patients receiving the combination of thrombectomy and medical therapy as opposed to medical therapy alone [3,4,5,6,7]
While STEMI-patients with a positive electrocardiogram are directly transported to the angiography-suite, stroke patients are usually first triaged with a noninvasive imaging method in one room, or even hospital, and transported to a different room, or even different hospital, for thrombectomy
Summary
Swift and complete reperfusion of the occluded vessel territory is the key of every revascularization therapy in stroke patients with large vessel occlusion (LVO) [1,2]. Biphasic FDCT angiography enabled us to reliable detect LVOs and grade collaterals [10] These advancements made the aforementioned paradigm feasible for the triage of mothership, who are eligible for IV lysis, as well as transfer patients. To examine if one-stop management reduces intrahospital treatment delays and improves functional outcome of acute stroke patients with large vessel occlusion. Door-to-reperfusion times and functional outcome at 90 days were recorded and compared in a case-control analysis with matched prior patients receiving standard management. Compared to 43 case-matched patients triaged with multidetector CT, median door-to-reperfusion time was reduced from 102 (IQR 85–117) to 68 min (IQR 53–89; p < 0.001). Conclusions: One-stop management for stroke triage reduces intrahospital time delays in our specific hospital setting
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