Background and Purpose: The 2015 Focused Update for the Acute Ischemic Stroke Guidelines emphasized the importance of rapid patient selection, optimization of endovascular procedures and organizations of systems of care. Our institution, which has been performing endovascular procedures using a rapid MRI/MRA imaging protocol, transitioned in 2015 to a CT/CTA/CTP imaging protocol. The goal of the study is to evaluate the impact of the transition to CTP on endovascular performance, as measured by door to imaging time and door to skin puncture, and the improvement of the neurological deficit measured by NIHSS difference at admission and discharge.
Methods: All endovascular procedures performed from January 2014 to May 2016 were reviewed from our prospective database. CT perfusion was performed with injection of 40 cc iodinated contrast and 40 seconds acquisition time. The CTA images were generated from the CT perfusion. Demographics, endovascular performance and discharged status were obtained. Continuous variables were assessed for normality by the Kolmogorov-Smirnov test. Non-parametric data were reported as median and analysed using the Kruskal-Wallis test or Wilcoxon Ranks test.
Results: A total of 91 thrombectomies were initially identified. The median age was 65 (IQR:53-77) with 52% males. 78% were anterior circulation strokes (ACS). Although the overall number of stroke admission remained relatively stable, the proportion of thrombectomies duplicated every year (23/1003 in 2014 vs. 38/1159 in 2015 vs. 32/632 until May 2016). Door to advance imaging median time (52 mins vs 24 mins vs.25 minutes; p=0.023) and door to skin puncture median time (130 mins vs. 100 mins vs. 81 mins; p=0.007) demonstrated significant differences in the ACS. A significant improvement in NIHSS at discharge was noted after implementation of the protocol (18 to 8; p=0.001 in 2015 and 17.5 to 8 in 2016; p=0.006 vs. 14 to 9 in 2014; p=0.777).
Conclusion: Transition to CT-based imaging protocols was associated with improvement in the delivery of endovascular acute care in a Comprehensive Center used to acute MRI imaging despite the logistic challenges and lack of familiarity with the new technique. Transition to CT-based imaging is a reasonable approach to improve endovascular care.