http://stroke.ahajournals.org/content/48/11/3152?etoc=
This article requires a subscription to view the full text. If
you have a subscription you may use the login form below to view the
article. Access to this article can also be purchased.
Abstract
Background and Purpose—Intrahospital
time delays significantly affect the neurological outcome of stroke
patients with large-vessel occlusion. This study was conducted to
determine whether a one-stop management can reduce intrahospital times
of patients with acute large-vessel occlusion.
Methods—In
this observational study, we report the first 30 consecutive stroke
patients imaged and treated in the same room. As part of our protocol,
we transported patients with a National Institutes of Health Stroke
Scale score of ≥10 directly to the angio suite, bypassing multidetector
computed tomography (CT). Preinterventional imaging consisted of
noncontrast flat detector CT and flat detector CT angiography, acquired
with an angiography system. Patients with large-vessel occlusions
remained on the angio table and were treated with mechanical
thrombectomy; patients with small artery occlusions were treated with
intravenous thrombolysis, whereas patients with an intracranial
hemorrhage and stroke mimics were treated as per guidelines.
Door-to-groin puncture times were recorded and compared with our past
results.
Results—Thirty
patients were transferred directly to our angio suite from June to
December 2016. The time from symptom onset to admission was 105 minutes.
Ischemic stroke was diagnosed in 22 of 30 (73%) patients, 4 of 30
(13.5%) had an intracranial hemorrhage, and 4 of 30 (13.5) were
diagnosed with a Todd’s paresis. Time from admission to groin puncture
was 20.5 minutes. Compared with 44 patients imaged with multidetector CT
in the first 6 months of 2016, door-to-groin times were significantly
reduced (54.5 minutes [95% confidence interval, 47–61] versus 20.5
minutes [95% confidence interval, 17–26]).
Conclusions—In
this small series, a one-stop management protocol of selected stroke
patients using latest generation flat detector CT led to a significant
reduction of intrahospital times.
No comments:
Post a Comment