One-Stop Management of 230 Consecutive Acute Stroke Patients: Report of Procedural Times and Clinical Outcome
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Selection
2.2. Image Acquisition and Processing
2.3. Management After Imaging
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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All, n = 230 | LVO, n = 166 | SVO, n = 25 | ICH, n = 24 | Todd’s, n = 11 | RLVO, n = 4 | |
---|---|---|---|---|---|---|
Age, median (IQR) | 78 (69–84) | 77 (68–84) | 79 (71–87) | 78 (75–83) | 79 (73–82) | 81 (77–86) |
Admission NIHSS | 15 (12–19) | 16 (13–19) | 13 (11–15) | 15 (10–17) | 12 (11–15) | 13 (11–13) |
Female | 123 (54%) | 90 (54%) | 12 (48%) | 12 (50%) | 5 (46%) | 4 (100%) |
IV–rtPA | 144 (63%) | 112 (68%) | 23 (92%) | 1 | 4 (36%) | 4 (100%) |
Hemorrhage on initial FDCT | 25 (11%) | 1 (1%) | 0 (0%) | 24 (100%) | 0 (0%) | 0 (0%) |
Occlusion site | ||||||
ICA-T | 41 (25%) | |||||
M1 | 88 (53%) | |||||
M2 | 15 (9%) | |||||
Other | 22 (13%) | |||||
Tandem occlusion | 34 (21%) | |||||
Times, min (IQR; 90th Percentile) | ||||||
Symptom to door | 130 (70–195; 253) | 154 (67–205; 264) | 82 (66–134; 205) | 105 (69–129; 204) | 131(95–146; 186) | 229 (181–259) |
Door to FDCT | 15 (10–20; 26) | 14 (9–19; 25) | 16 (12–24; 32) | 17 (14–22; 30) | 21 (13–23; 31) | 16 (14–16) |
Door to IV–rtPA | 22 (20–30; 41) | 22 (20–29; 38) | 26 (20–45; 53) | |||
Door to treatment startα | 21 (18–33; 34) | 27 (19–32; 37) | ||||
Door to groin | 29 (22–39; 50) | |||||
Groin to reperfusion | 40 (28–60; 80) | |||||
FDCT to reperfusion | 59 (45–82; 101) | |||||
Door to reperfusion | 72 (58–91; 117) | |||||
Door to reperfusion M1 | 64 (56–87; 102) | |||||
extCT to FDCT | 124 (110–155; 218) | |||||
Direct admission | 127 (55%) | 74 (45%) | 19 (76%) | 23 (96%) | 11 (100%) | 0 (0%) |
Working hoursβ | 95 (41%) | 68 (41%) | 13 (52%) | 11 (46%) | 2 (18%) | 1 (25%) |
Reperfusion, mTICI2b-3 | 142 (86%) | |||||
Any hemorrhage on FU | 49 (21%) | 25 (15%) | 0 (0%) | 24 (100%) | 0 (0%) | |
PH-2 hematoma on FU | 2 (1%) | |||||
sICH | 6 (4%) | |||||
Discharge NIHSS | 5 (2–10) | 5 (2–12) | 7 (4–10) | 5 (1–9) | 4 (1–6) | 6 (4–7) |
Discharge mRS | 4 (1–5) | 4 (1–5) | 4 (2–5) | 2 (2–6) | 3 (1–4) | 3 (3–4) |
Mortality | 45/230 (20%) | 36 (22%) | 2 (8%) | 5 (30%) | 2 (18%) | 0 (0%) |
90 d mRS | 4 (1–6) | |||||
90 d favorable outcome | 54/147 (37%) |
Direct Admission n = 74 | Min (IQR; 90th Percentile) |
---|---|
Door to FDCT | 15 (12–20; 24) |
Door to IV–rtPA | 22 (20–29; 38) |
Door to groin | 34 (28–45; 51) |
Groin to reperfusion | 41 (26–55; 73) |
FDCT to reperfusion | 61 (47–81; 93) |
Door to reperfusion | 76 (61–92; 116) |
Door to reperfusion of M1 | 68 (58–89; 101) |
Occluded vessel | ICA-T 13 (18%), M1 42 (58%), M2 9 (12%) |
Tandem occlusions | 15 (20%) |
Transfer patients n = 92 | |
extCT to FDCT | 124 (110–155; 218) |
Door to FDCT | 10 (8–17; 25) |
Door to groin | 25 (19–33; 41) |
Groin to reperfusion | 38 (29–65; 87) |
FDCT to reperfusion | 56 (44–86; 110) |
Door to reperfusion | 68 (53–90; 126) |
Door to reperfusion of M1 | 59 (52–84; 118) |
Occluded vessel | ICA-T 28 (30%), M1 46 (50%), M2 6 (7%) |
Tandem occlusions | 19 (20%) |
Working hours n = 68 | |
Door to FDCT | 12 (7–16; 21) |
Door to IV–rtPA | 22 (20–26; 34) |
Door to groin | 25 (19–33; 41) |
Groin to reperfusion | 38 (25–53; 85) |
FDCT to reperfusion | 61 (42–69; 101) |
Door to reperfusion | 66 (52–85; 105) |
Off-hours n = 98 | |
Door to FDCT | 15 (10–21; 27) |
Door to IV–rtPA | 23 (19–29; 38) |
Door to groin | 33 (25–42; 60) |
Groin to reperfusion | 38 (25–53; 86) |
FDCT to reperfusion | 52 (42–69; 101) |
Door to reperfusion | 66 (52–85; 105) |
MDCT, n = 43 | FDCT, n = 43 | p-Value | |
---|---|---|---|
Age median (IQR) * | 77 (69–81) | 77 (69–82) | 0.962 |
Admission NIHSS * | 17 (14–20) | 16 (13–20) | 0.796 |
CT ASPECTS * | 8 (7–9) | 9 (7–10) | 0.138 |
Onset to door, min (IQR; 90th) * | 129 (76–200; 244) | 160 (74–202; 221) | 0.511 |
Female | 26 (61%) | 26 (61%) | 1.000 |
IV-rtPA | 36 (84%) | 30 (70%) | 0.201 |
Hypertension | 35 (81%) | 33 (77%) | 0.791 |
Hyperlipidemia | 14 (33%) | 20 (47%) | 0.266 |
PAD | 2 (5%) | 5 (12%) | 0.433 |
DM | 11 (26%) | 17 (40%) | 0.249 |
Collateral grading | 7 (5–8) | 7 (4–8) | 0.699 |
Direct admissions | 30 (70%) | 18 (42%) | 0.016 |
Working hours | 22 (51%) | 19 (44%) | 0.666 |
Door to CT, min (IQR; 90th) | 15 (11–20; 24) | 9 (6–14; 16) | <0.001 |
Door to IV-rtPA | 27 (22–34; 35) | 19 (12–22; 34) | 0.016 |
Door to groin | 60 (48–68; 79) | 25 (19–30; 38) | <0.001 |
Working hours | 60 (42–65; 85) | 21 (17–25; 41) | <0.001 |
Off-hours | 62 (53–69; 75) | 25 (21–32; 38) | <0.001 |
Direct admissions | 61 (54–67; 83) | 26 (25–38; 44) | <0.001 |
Transfer patients | 40 (30–69; 75) | 21 (19–26; 35) | <0.001 |
Groin to reperfusion | 42 (27–62; 94) | 43 (33–60; 78) | 0.866 |
CT to reperfusion | 84 (71–99; 144) | 59 (44–75; 96) | <0.001 |
Door to reperfusion | 102 (85–117; 166) | 68 (53–89; 104) | <0.001 |
Working hours | 102 (79–145; 191) | 62 (52–81; 104) | 0.006 |
Off-hours | 103 (93–116; 126) | 74 (55–90; 109) | <0.001 |
Direct admissions | 103 (85–121; 184) | 72 (58–87; 103) | 0.001 |
Transfer patients | 102 (68–109; 120) | 64 (51–88; 108) | 0.05 |
ICA-T | 7 (16%) | 13 (30%) | 0.179 |
M1 | 26 (61%) | 25 (58%) | 0.888 |
M2 | 9 (21%) | 3 (7%) | 0.117 |
Tandem occlusion | 6 (14%) | 7 (16%) | 1 |
Successful reperfusion (mTICI2b-3) | 31 (72%) | 38 (88%) | 0.102 |
sICH | 3 (7%) | 2 (5%) | 1 |
Any hemorrhage | 11 (26%) | 7 (16%) | 0.427 |
PH–2 hemorrhage | 1 (2%) | 1 (2%) | 1 |
Discharge mRS | 4 (2–5) | 3 (1–5) | 0.374 |
90d mRS | 4 (1–5) | 2 (1–5) | 0.153 |
90d mRS of 0–2 | 14 (33%) | 25 (58%) | 0.029 |
Mortality | 9 (21%) | 10 (23%) | 1 |
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Psychogios, M.-N.; Maier, I.L.; Tsogkas, I.; Hesse, A.C.; Brehm, A.; Behme, D.; Schnieder, M.; Schregel, K.; Papageorgiou, I.; Liebeskind, D.S.; et al. One-Stop Management of 230 Consecutive Acute Stroke Patients: Report of Procedural Times and Clinical Outcome. J. Clin. Med. 2019, 8, 2185. https://doi.org/10.3390/jcm8122185
Psychogios M-N, Maier IL, Tsogkas I, Hesse AC, Brehm A, Behme D, Schnieder M, Schregel K, Papageorgiou I, Liebeskind DS, et al. One-Stop Management of 230 Consecutive Acute Stroke Patients: Report of Procedural Times and Clinical Outcome. Journal of Clinical Medicine. 2019; 8(12):2185. https://doi.org/10.3390/jcm8122185
Chicago/Turabian StylePsychogios, Marios-Nikos, Ilko L. Maier, Ioannis Tsogkas, Amélie Carolina Hesse, Alex Brehm, Daniel Behme, Marlena Schnieder, Katharina Schregel, Ismini Papageorgiou, David S. Liebeskind, and et al. 2019. "One-Stop Management of 230 Consecutive Acute Stroke Patients: Report of Procedural Times and Clinical Outcome" Journal of Clinical Medicine 8, no. 12: 2185. https://doi.org/10.3390/jcm8122185
APA StylePsychogios, M.-N., Maier, I. L., Tsogkas, I., Hesse, A. C., Brehm, A., Behme, D., Schnieder, M., Schregel, K., Papageorgiou, I., Liebeskind, D. S., Goyal, M., Bähr, M., Knauth, M., & Liman, J. (2019). One-Stop Management of 230 Consecutive Acute Stroke Patients: Report of Procedural Times and Clinical Outcome. Journal of Clinical Medicine, 8(12), 2185. https://doi.org/10.3390/jcm8122185