Introduction: Intrahospital time delays significantly affect neurological outcome of stroke patients with large vessel occlusion. Conventional imaging prior to thrombectomy leads to time delays. We report the 100 first consecutive (mothership and transfer) patients triaged in our department with a one stop management, based on flat detector CT (FDCT) and FDCTA.
Methods: In this observational study, we transported stroke patients with an NIHSS ≥ 7 directly to the angio suite, bypassing multidetector CT. Multimodal imaging consisted of noncontrast FDCT and biphasic FDCTA. Patients with large vessel occlusion remained on the angio table and were treated with intravenous rtPA, if no exclusion criteria were present, and thrombectomy; peripheral occlusions were treated with intravenous rtPA; intracranial hemorrhage and stroke mimics were treated as per guidelines. Intrahospital times as well as outcomes were recorded and compared to past patients with a case-control analysis, matched for age, admission NIHSS, ASPECTS and symptom-to-door time.
Results: One-hundred consecutive patients were transferred directly to our angio suite. Mean age was 77 (IQR 69-83). Symptom onset to admission time was 137 min (IQR 70-187). Ischemic stroke was diagnosed in 79 patients, intracranial hemorrhage was present in 11 and Todd`s paresis in 10 patients. We recorded a median door-to-groin time of 25 min (IQR 19-29) and door-to-reperfusion time of 68 min (IQR 53-89). Compared to patients triaged with multidetector CT, we observed a highly significant reduction of door-to-groin times (60 min (95% CI 54-65) to 25 min (95% CI 21-26); P<0.001). Median mRS at 90 days was lower in the FDCT group (MDCT group 4 (95% CI 3-5) to FDCT group 2 (95% CI 2-4); P=0.168). Mortality (21 vs. 23%), sICH (7 vs. 5%) and any hemorrhage (25% vs. 17%) rates were comparable.
Conclusions: One stop management is feasible for stroke triage and results in reduction of intrahospital times and improved functional outcomes.