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

Abstract

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.

Automated Perfusion Calculations vs. Visual Scoring of Collaterals and CBV-ASPECTS

“…Another potential shortcoming of a perfusion-based paradigm is that the emerging one-stop management for stroke treatment (utilizing a flat-detector CT in the angiography suite) has not been evaluated in large patient cohorts with perfusion-based triage paradigms so far [ 22 ], while collateral scoring functions relatively well [ 23 ]. This deprives late time-window acute stroke patients of a potential time-saving effect of up to 40 min due to a reduction of in-hospital time delays [ 24 , 25 ].…”

How to Improve the Management of Acute Ischemic Stroke by Modern Technologies, Artificial Intelligence, and New Treatment Methods

“…Psychogios et al reported study of 230 patients and a significant reduction of median door-to-reperfusion time (from 102 to 68 min; p < 0.001) and significantly better rate of good functional outcome (p = 0.029) in the one-stop management group [42]. Fewer radiation doses and fewer posterior fossa artifacts can be achieved by CBCT usage [42].…”

Acute reperfusion therapies for acute ischemic stroke patients with unknown time of symptom onset or in extended time windows: an individualized approach

“…Such a development will eventually allow for rapid patient selection and prompt treatment with IVT and EVT in eligible patients even in extended time windows. 155 …”