Understanding Delays in MRI-based Selection of Large Vessel Occlusion Stroke Patients for Endovascular Thrombectomy

被引：9

作者：

Regenhardt, Robert W. ^{[1
,2
]}

Nolan, Neal M. ^{[2
]}

Rosenthal, Joseph A. ^{[2
]}

McIntyre, Joyce A. ^{[2
]}

Bretzner, Martin ^{[2
]}

Bonkhoff, Anna K. ^{[2
]}

Snider, Samuel B. ^{[2
]}

Das, Alvin S. ^{[2
]}

Alotaibi, Naif M. ^{[1
]}

Vranic, Justin E. ^{[1
,3
]}

Dmytriw, Adam A. ^{[1
,3
]}

Stapleton, Christopher J. ^{[1
]}

Patel, Aman B. ^{[1
]}

Rost, Natalia S. ^{[2
]}

Leslie-Mazwi, Thabele M. ^{[1
,2
]}

机构：

[1] Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurosurg, 55 Fruit St, Boston, MA 02114 USA

[2] Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurol, Boston, MA 02114 USA

[3] Harvard Med Sch, Massachusetts Gen Hosp, Dept Radiol, Boston, MA 02114 USA

来源：

CLINICAL NEURORADIOLOGY | 2022年 / 32卷 / 04期

关键词：

Ischemic stroke; Systems of care; Process improvement; Magnetic resonance imaging; ACUTE ISCHEMIC-STROKE; TISSUE-PLASMINOGEN ACTIVATOR; GENERAL-ANESTHESIA; OUTCOMES; REVASCULARIZATION; METAANALYSIS; DISPARITIES; THERAPY; INFARCT; CARE;

D O I：

10.1007/s00062-022-01165-y

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Purpose Given the efficacy of endovascular thrombectomy (EVT), optimizing systems of delivery is crucial. Magnetic resonance imaging (MRI) is the gold standard for evaluating tissue viability but may require more time to obtain and interpret. We sought to identify determinants of arrival-to-puncture time for patients who underwent MRI-based EVT selection in a real-world setting. Methods Patients were identified from a prospectively maintained database from 2011-2019 that included demographics, presentations, treatments, and outcomes. Process times were obtained from the medical charts. MRI times were obtained from time stamps on the first sequence. Linear and logistic regressions were used to infer explanatory variables of arrival-to-puncture times and effects of arrival-to-puncture time on functional outcomes. Results In this study 192 patients (median age 70 years, 57% women, 12% non-white) underwent MRI-based EVT selection. 66% also underwent computed tomography (CT) at the hub before EVT. General anesthesia was used for 33%. Among the entire cohort, the median arrival-to-puncture was 102 min; however, among those without CT it was 77 min. Longer arrival-to-puncture times independently reduced the odds of 90-day good outcome ( increment mRS <= 2 from pre-stroke, aOR = 0.990, 95%CI = 0.981-0.999, p = 0.040) when controlling for age, NIHSS, and good reperfusion (TICI 2b-3). Independent determinants of longer arrival-to-puncture were CT plus MRI (beta = 0.205, p = 0.003), non-white race/ethnicity (beta = 0.162, p = 0.012), coronary disease (beta = 0.205, p = 0.001), and general anesthesia (beta = 0.364, p < 0.0001). Conclusion Minimizing arrival-to-puncture time is important for outcomes. Real-world challenges exist in an MRI-based EVT selection protocol; avoiding double imaging is key to saving time. Racial/ethnic disparities require further study. Understanding variables associated with delay will inform protocol changes.

引用

页码：979 / 986

页数：8

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