Imaging triage of acute stroke patients for endovascular clot retrieval: Effect of increased therapeutic window on the utilization of CT perfusion

被引：0

作者：

Fernandez, Michelle ^{[1
]}

Farmer, Caitlin ^{[1
]}

Egerton-Warburton, Diana ^{[2
,6
]}

Clark, Jennifer ^{[1
]}

Paul, Eldho ^{[3
]}

Chong, Winston ^{[1
,4
,5
]}

Goergen, Stacy K. ^{[1
,4
,5
]}

机构：

[1] Monash Hlth, Monash Imaging, Melbourne, Vic, Australia

[2] Monash Hlth, Monash Emergency, Melbourne, Vic, Australia

[3] Monash Ctr Hlth Res & Implementat, Sch Publ Hlth & Prevent Med, Melbourne, Vic, Australia

[4] Monash Univ, Sch Clin Sci, Dept Surg, Melbourne, Vic, Australia

[5] Monash Univ, Sch Clin Sci, Dept Imaging, Melbourne, Vic, Australia

[6] Monash Univ, Sch Clin Sci, Melbourne, Vic, Australia

来源：

JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY | 2021年 / 65卷 / 02期

关键词：

brain ischaemia; computed tomography perfusion; patient discharge; stroke; thrombectomy; ISCHEMIC-STROKE; INTRAVENOUS ALTEPLASE; THROMBECTOMY; ONSET;

D O I：

10.1111/1754-9485.13122

中图分类号：

R8 [特种医学]; R445 [影像诊断学];

学科分类号：

1002 ; 100207 ; 1009 ;

摘要：

Introduction Recent randomized trials showing improved outcomes for later-presenting acute ischaemic stroke (AIS) patients with large vessel occlusion (LVO) treated with endovascular clot retrieval (ECR) may result in substantial increases in CTP utilization. This 3-hospital, single-institution cohort study aimed to compare 2017 and 2018 patient cohorts for the following: CTP use in AIS. Prevalence of LVO in all patients having CTP. Number and clinical characteristics of patients triaged to ECR. Number of patients receiving CTP relative to similar-acuity total ED presentations. Methods Inclusion criteria: Consecutive adult emergency (ED) patients receiving CTP for suspected AIS. Study period 1:1 January-30 June 2017; Period 2:1 January-30 June 2018. Data collection: age, gender, triage category, NIHSS (National Institute of Health Stroke Score), symptoms/signs, time elapsed since last seen well (TESLSW) to triage, disposition (home/other). Results A 38.7 % increase in CTP (512 in 2017, 710 in 2018) occurred with 39/512 (7.6%) and 72/710 (10.1%) having intended ECR. CTPs per intended ECR declined from 13.1 to 9.9. 36/512 (7.0%) and 58/710 (8.2%) patients had ECR (61.1% increase) and 22/36 (61.1%) and 25/58 (43.1%) of these were discharged home in 2017 and 2018, respectively, an increase of 3/22(14%). Conclusion Despite a 38.7% increase in CTP utilization, we experienced a reduction in the number of CTPs performed/patient triaged to ECR. This did not reflect higher LVO prevalence among later presenters but may reflect changed selection criteria for CTP and/or decision making about suitability for ECR.

引用

页码：152 / 159

页数：8

共 16 条

[1] Late Window Paradox [J].

Albers, Gregory W. .

STROKE, 2018, 49 (03) :768-771

[2] A multicenter randomized controlled trial of endovascular therapy following imaging evaluation for ischemic stroke (DEFUSE 3) [J].

Albers, Gregory W. ;

Lansberg, Maarten G. ;

Kemp, Stephanie ;

Tsai, Jenny P. ;

Lavori, Phil ;

Christensen, Soren ;

Mlynash, Michael ;

Kim, Sun ;

Hamilton, Scott ;

Yeatts, Sharon D. ;

Palesch, Yuko ;

Bammer, Roland ;

Broderick, Joe ;

Marks, Michael P. .

INTERNATIONAL JOURNAL OF STROKE, 2017, 12 (08) :896-905

[3] A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke [J].

Berkhemer, O. A. ;

Fransen, P. S. S. ;

Beumer, D. ;

van den Berg, L. A. ;

Lingsma, H. F. ;

Yoo, A. J. ;

Schonewille, W. J. ;

Vos, J. A. ;

Nederkoorn, P. J. ;

Wermer, M. J. H. ;

van Walderveen, M. A. A. ;

Staals, J. ;

Hofmeijer, J. ;

van Oostayen, J. A. ;

Nijeholt, G. J. Lycklama A. ;

Boiten, J. ;

Brouwer, P. A. ;

Emmer, B. J. ;

de Bruijn, S. F. ;

van Dijk, L. C. ;

Kappelle, L. J. ;

Lo, R. H. ;

Van Dijk, E. J. ;

de Vries, J. ;

de Kort, P. L. M. ;

van Rooij, W. J. J. ;

van den Berg, J. S. P. ;

van Hasselt, B. A. A. M. ;

Aerden, L. A. M. ;

Dallinga, R. J. ;

Visser, M. C. ;

Bot, J. C. J. ;

Vroomen, P. C. ;

Eshghi, O. ;

Schreuder, T. H. C. M. L. ;

Heijboer, R. J. J. ;

Keizer, K. ;

Tielbeek, A. V. ;

den Hertog, H. M. ;

Gerrits, D. G. ;

van den Berg-Vos, R. M. ;

Karas, G. B. ;

Steyerberg, E. W. ;

Flach, H. Z. ;

Marquering, H. A. ;

Sprengers, M. E. S. ;

Jenniskens, S. F. M. ;

Beenen, L. F. M. ;

van den Berg, R. ;

Koudstaal, P. J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (01) :11-20

[4] Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial [J].

Bracard, Serge ;

Ducrocq, Xavier ;

Mas, Jean Louis ;

Soudant, Marc ;

Oppenheim, Catherine ;

Moulin, Thieriy ;

Guillemin, Francis .

LANCET NEUROLOGY, 2016, 15 (11) :1138-1147

[5] Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection [J].

Campbell, B. C. V. ;

Mitchell, P. J. ;

Kleinig, T. J. ;

Dewey, H. M. ;

Churilov, L. ;

Yassi, N. ;

Yan, B. ;

Dowling, R. J. ;

Parsons, M. W. ;

Oxley, T. J. ;

Wu, T. Y. ;

Brooks, M. ;

Simpson, M. A. ;

Miteff, F. ;

Levi, C. R. ;

Krause, M. ;

Harrington, T. J. ;

Faulder, K. C. ;

Steinfort, B. S. ;

Priglinger, M. ;

Ang, T. ;

Scroop, R. ;

Barber, P. A. ;

McGuinness, B. ;

Wijeratne, T. ;

Phan, T. G. ;

Chong, W. ;

Chandra, R. V. ;

Bladin, C. F. ;

Badve, M. ;

Rice, H. ;

de Villiers, L. ;

Ma, H. ;

Desmond, P. M. ;

Donnan, G. A. ;

Davis, S. M. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1009-1018

[6] Extending thrombolysis to 4.5-9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data [J].

Campbell, Bruce C., V ;

Ma, Henry ;

Ringleb, Peter A. ;

Parsons, Mark W. ;

Churilov, Leonid ;

Bendszus, Martin ;

Levi, Christopher R. ;

Hsu, Chung ;

Kleinig, Timothy J. ;

Fatar, Marc ;

Leys, Didier ;

Molina, Carlos ;

Wijeratne, Tissa ;

Curtze, Sami ;

Dewey, Helen M. ;

Barber, P. Alan ;

Butcher, Kenneth S. ;

De Silva, Deidre A. ;

Bladin, Christopher F. ;

Yassi, Nawaf ;

Pfaff, Johannes A. R. ;

Sharma, Gagan ;

Bivard, Andrew ;

Desmond, Patricia M. ;

Schwab, Stefan ;

Schellinger, Peter D. ;

Yan, Bernard ;

Mitchell, Peter J. ;

Serena, Joaquin ;

Toni, Danilo ;

Thijs, Vincent ;

Hacke, Werner ;

Davis, Stephen M. ;

Donnan, Geoffrey A. .

LANCET, 2019, 394 (10193) :139-147

[7] Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke [J].

Goyal, M. ;

Demchuk, A. M. ;

Menon, B. K. ;

Eesa, M. ;

Rempel, J. L. ;

Thornton, J. ;

Roy, D. ;

Jovin, T. G. ;

Willinsky, R. A. ;

Sapkota, B. L. ;

Dowlatshahi, D. ;

Frei, D. F. ;

Kamal, N. R. ;

Montanera, W. J. ;

Poppe, A. Y. ;

Ryckborst, K. J. ;

Silver, F. L. ;

Shuaib, A. ;

Tampieri, D. ;

Williams, D. ;

Bang, O. Y. ;

Baxter, B. W. ;

Burns, P. A. ;

Choe, H. ;

Heo, J. -H. ;

Holmstedt, C. A. ;

Jankowitz, B. ;

Kelly, M. ;

Linares, G. ;

Mandzia, J. L. ;

Shankar, J. ;

Sohn, S. -I. ;

Swartz, R. H. ;

Barber, P. A. ;

Coutts, S. B. ;

Smith, E. E. ;

Morrish, W. F. ;

Weill, A. ;

Subramaniam, S. ;

Mitha, A. P. ;

Wong, J. H. ;

Lowerison, M. W. ;

Sajobi, T. T. ;

Hill, M. D. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1019-1030

[8] Thrombectomy within 8 Hours after Symptom Onset in Ischemic Stroke [J].

Jovin, T. G. ;

Chamorro, A. ;

Cobo, E. ;

de Miquel, M. A. ;

Molina, C. A. ;

Rovira, A. ;

San Roman, L. ;

Serena, J. ;

Abilleira, S. ;

Ribo, M. ;

Millan, M. ;

Urra, X. ;

Cardona, P. ;

Lopez-Cancio, E. ;

Tomasello, A. ;

Castano, C. ;

Blasco, J. ;

Aja, L. ;

Dorado, L. ;

Quesada, H. ;

Rubiera, M. ;

Hernandez-Perez, M. ;

Goyal, M. ;

Demchuk, A. M. ;

von Kummer, R. ;

Gallofre, M. ;

Davalos, A. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (24) :2296-2306

[9] Endovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: A randomized care trial [J].

Khoury, Naim N. ;

Darsaut, Tim E. ;

Ghostine, Jimmy ;

Deschaintre, Yan ;

Daneault, Nicole ;

Durocher, Andre ;

Lanthier, Sylvain ;

Pope, Alexandre Y. ;

Odier, Celine ;

Lebrun, Louise-Helene ;

Guilbert, Francois ;

Gentric, Jean-Christophe ;

Batista, Andre ;

Weill, Alain ;

Roy, Daniel ;

Bracard, Serge ;

Raymond, Jean .

JOURNAL OF NEURORADIOLOGY, 2017, 44 (03) :198-202

[10] Prevalence of large vessel occlusion in patients presenting with acute ischemic stroke: a 10-year systematic review of the literature [J].

Lakomkin, Nikita ;

Dhamoon, Mandip ;

Carroll, Kirsten ;

Singh, Inder Paul ;

Tuhrim, Stanley ;

Lee, Joyce ;

Fifi, Johanna T. ;

Mocco, J. .

JOURNAL OF NEUROINTERVENTIONAL SURGERY, 2019, 11 (03) :241-245

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