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

Marios-Nikos Psychogios; Ilko L Maier; Ioannis Tsogkas; Amélie Carolina Hesse; Alex Brehm; Daniel Behme; Marlena Schnieder; Katharina Schregel; Ismini Papageorgiou; David S Liebeskind; Mayank Goyal; Mathias Bähr; Michael Knauth; Jan Liman

doi:10.3390/jcm8122185

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

J Clin Med. 2019 Dec 11;8(12):2185. doi: 10.3390/jcm8122185.

Authors

Affiliations

¹ Department of Neuroradiology, University Medical Center Goettingen, 37075 Goettingen, Germany.
² Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, 4031 Basel, Switzerland.
³ Department of Neurology, University Medical Center Goettingen, 37075 Goettingen, Germany.
⁴ Department of Neuroradiology, Südharz Klinikum, 99734 Nordhausen, Germany.
⁵ Neurovascular Imaging Research Core and Stroke Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA 90095, USA.
⁶ Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB 2500, Canada.

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.

Keywords: cerebral angiography; cone-beam computed tomography; hemorrhage; stroke; thrombectomy.