One-Stop Management of 230 Consecutive Acute Stroke Patients: Report of Procedural Times and Clinical Outcome

被引：48

作者：

Psychogios, Marios-Nikos ^{[1
,2
]}

Maier, Ilko L. ^{[3
]}

Tsogkas, Ioannis ^{[1
]}

Hesse, Amelie Carolina ^{[1
]}

Brehm, Alex ^{[1
,2
]}

Behme, Daniel ^{[1
]}

Schnieder, Marlena ^{[3
]}

Schregel, Katharina ^{[1
]}

Papageorgiou, Ismini ^{[4
]}

Liebeskind, David S. ^{[5
]}

Goyal, Mayank ^{[6
]}

Baehr, Mathias ^{[3
]}

Knauth, Michael ^{[1
]}

Liman, Jan ^{[3
]}

机构：

[1] Univ Med Ctr Goettingen, Dept Neuroradiol, D-37075 Gottingen, Germany

[2] Univ Hosp Basel, Dept Neuroradiol, Clin Radiol & Nucl Med, CH-4031 Basel, Switzerland

[3] Univ Med Ctr Goettingen, Dept Neurol, D-37075 Gottingen, Germany

[4] Sudharz Klinikum, Dept Neuroradiol, D-99734 Nordhausen, Germany

[5] Univ Calif Los Angeles, Neurovasc Imaging Res Core & Stroke Ctr, Dept Neurol, Los Angeles, CA 90095 USA

[6] Univ Calgary, Dept Clin Neurosci, Calgary Stroke Program, Calgary, AB 2500, Canada

来源：

JOURNAL OF CLINICAL MEDICINE | 2019年 / 8卷 / 12期

关键词：

stroke; hemorrhage; thrombectomy; cone-beam computed tomography; cerebral angiography; ISCHEMIC-STROKE; ENDOVASCULAR THROMBECTOMY; STENT-RETRIEVER; WORKFLOW; SUITE;

D O I：

10.3390/jcm8122185

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页数：13

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