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

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 outco...

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Autores principales: Psychogios, Marios-Nikos, Maier, Ilko L., Tsogkas, Ioannis, Hesse, Amélie Carolina, Brehm, Alex, Behme, Daniel, Schnieder, Marlena, Schregel, Katharina, Papageorgiou, Ismini, Liebeskind, David S., Goyal, Mayank, Bähr, Mathias, Knauth, Michael, Liman, Jan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947228/
https://www.ncbi.nlm.nih.gov/pubmed/31835763
http://dx.doi.org/10.3390/jcm8122185
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author Psychogios, Marios-Nikos
Maier, Ilko L.
Tsogkas, Ioannis
Hesse, Amélie Carolina
Brehm, Alex
Behme, Daniel
Schnieder, Marlena
Schregel, Katharina
Papageorgiou, Ismini
Liebeskind, David S.
Goyal, Mayank
Bähr, Mathias
Knauth, Michael
Liman, Jan
author_facet Psychogios, Marios-Nikos
Maier, Ilko L.
Tsogkas, Ioannis
Hesse, Amélie Carolina
Brehm, Alex
Behme, Daniel
Schnieder, Marlena
Schregel, Katharina
Papageorgiou, Ismini
Liebeskind, David S.
Goyal, Mayank
Bähr, Mathias
Knauth, Michael
Liman, Jan
author_sort Psychogios, Marios-Nikos
collection PubMed
description 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.
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spelling pubmed-69472282020-01-13 One-Stop Management of 230 Consecutive Acute Stroke Patients: Report of Procedural Times and Clinical Outcome Psychogios, Marios-Nikos Maier, Ilko L. Tsogkas, Ioannis Hesse, Amélie Carolina Brehm, Alex Behme, Daniel Schnieder, Marlena Schregel, Katharina Papageorgiou, Ismini Liebeskind, David S. Goyal, Mayank Bähr, Mathias Knauth, Michael Liman, Jan J Clin Med Article 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. MDPI 2019-12-11 /pmc/articles/PMC6947228/ /pubmed/31835763 http://dx.doi.org/10.3390/jcm8122185 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Psychogios, Marios-Nikos
Maier, Ilko L.
Tsogkas, Ioannis
Hesse, Amélie Carolina
Brehm, Alex
Behme, Daniel
Schnieder, Marlena
Schregel, Katharina
Papageorgiou, Ismini
Liebeskind, David S.
Goyal, Mayank
Bähr, Mathias
Knauth, Michael
Liman, Jan
One-Stop Management of 230 Consecutive Acute Stroke Patients: Report of Procedural Times and Clinical Outcome
title One-Stop Management of 230 Consecutive Acute Stroke Patients: Report of Procedural Times and Clinical Outcome
title_full One-Stop Management of 230 Consecutive Acute Stroke Patients: Report of Procedural Times and Clinical Outcome
title_fullStr One-Stop Management of 230 Consecutive Acute Stroke Patients: Report of Procedural Times and Clinical Outcome
title_full_unstemmed One-Stop Management of 230 Consecutive Acute Stroke Patients: Report of Procedural Times and Clinical Outcome
title_short One-Stop Management of 230 Consecutive Acute Stroke Patients: Report of Procedural Times and Clinical Outcome
title_sort one-stop management of 230 consecutive acute stroke patients: report of procedural times and clinical outcome
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947228/
https://www.ncbi.nlm.nih.gov/pubmed/31835763
http://dx.doi.org/10.3390/jcm8122185
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