Abstract
Delays to reperfusion negatively impact outcomes of patients with ischemic stroke, yet current guidelines recommend selective sequential imaging for thrombectomy candidates. We aimed to quantify and analyze time delays associated with rescanning in sequential acute stroke imaging. This was a retrospective cohort study of consecutive patients with acute ischemic stroke who underwent imaging for treatment decision-making from January 1, 2017, to June 30, 2020. Rescan time delay was defined as ≥10-minute difference between initial NCCT and CTA ± CTP. Mean rescan time delays in comprehensive and primary stroke centers were compared. Bivariate and multivariable regression analyses assessed clinical and imaging factors associated with rescanning time delays and early outcomes. A total of 588 patients with acute ischemic were included in statistical analyses. Rescanning occurred in 27.9% (164/588 patients), with a mean time delay of 53.7 (SD, 43.4) minutes. For patients presenting at primary compared with comprehensive stroke centers, rescan time delays were more common (59.6% versus 11.8%, P < .001), with longer delays (65.4 [SD, 45.4] minutes versus 23.6 [SD, 14.0] minutes, P < .001). Independent predictors of rescan time delays included primary stroke center presentation, intravenous thrombolysis administration, black race, admission NIHSS ≥10, baseline independent ambulation, and onset-to-comprehensive stroke center arrival in ≥6 hours. Protocols for early simultaneous comprehensive CT (NCCT + CTA + CTP) were associated with lower odds of time delays (OR = 0.34; 95% CI, 0.21-0.55). Rescanning was associated with lower odds of home discharge (OR = 0.53; 95% CI, 0.30-0.95). A sequential approach to CT-based imaging may be significantly associated with prolonged acute stroke evaluations. Adoption of early simultaneous comprehensive CT could minimize treatment delays and improve outcomes.
Highlights
BACKGROUND AND PURPOSEDelays to reperfusion negatively impact outcomes of patients with ischemic stroke, yet current guidelines recommend selective sequential imaging for thrombectomy candidates
Treating select patients with acute ischemic stroke with endovascular thrombectomy up to 24 hours from last known well increases the proportion of patients with large-vessel occlusion who have an independent functional outcome.[1,2,3,4,5,6,7]
We required that transfer patients meet additional criteria, including the following: 1) NCCT and CTA were performed at the referring site to assess thrombectomy eligibility within the 6 hours before comprehensive stroke center door time, and 2) CTP was the first imaging completed at the comprehensive stroke center within 1 hour of arrival
Summary
We aimed to quantify and analyze time delays associated with rescanning in sequential acute stroke imaging. We aimed to quantify the time it takes to rescan patients with acute ischemic stroke with CTA 6 CTP following NCCT at comprehensive and primary stroke centers within the same stroke network. We aimed to focus our inclusion criteria on patients who were most likely undergoing evaluation for endovascular treatment and not purely for secondary stroke-prevention evaluation; this feature is a strength of this study because delayed imaging is not a main concern to patients outside endovascular treatment considerations
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
