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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Evaluation of computed tomography perfusion and angiogram use in stroke evaluation for thrombectomy at a community
Cal D Zahn1, Hayden L Smith2, Jonathan R Hurdelbrink2,3
1Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
Insights
This study evaluated computed tomography perfusion and angiogram (CT-P/A) use for thrombectomy screening. Results show variations in treatment decisions, particularly for patients not meeting strict clinical criteria, highlighting the need for further research.
Area of Science:
- Neurology
- Radiology
- Emergency Medicine
Background:
- Mechanical thrombectomy has improved outcomes for acute ischemic stroke.
- Clinical guidelines (DAWN, DEFUSE-3) dictate patient selection for thrombectomy.
- Computed tomography perfusion and angiogram (CT-P/A) is a key diagnostic tool for stroke assessment.
Purpose of the Study:
- To assess adherence to clinical guidelines for thrombectomy screening using CT-P/A in an emergency department setting.
- To evaluate the utilization of CT-P/A in stroke patients presenting to the emergency department.
- To analyze treatment decisions based on CT-P/A findings in relation to established thrombectomy criteria.
Main Methods:
- Retrospective observational study of adult patients undergoing CT-P/A in a US Midwestern emergency department (September 2019 - June 2021).
- Review of healthcare system records for patient demographics, CT-P/A results, and subsequent treatment decisions.
- Analysis of patient cohorts based on meeting or not meeting DAWN and DEFUSE-3 criteria for thrombectomy.
Main Results:
- Out of 68,403 ED visits, 718 (1.1%) received a CT-P/A.
- 105 patients were transferred for potential thrombectomy; 74 received the procedure.
- Patients meeting DAWN criteria had higher transfer (91.3%) and procedure (95.2%) rates compared to those not meeting criteria (64.2% procedure rate).
- Similarly, patients meeting DEFUSE-3 criteria had higher transfer (89.1%) and procedure (91.8%) rates compared to those not meeting criteria (50.9% procedure rate).
Conclusions:
- CT-P/A is utilized in emergency departments for stroke assessment, including in patients outside established thrombectomy criteria.
- Observed variations in treatment decisions suggest a need to refine the application of CT-P/A in stroke care.
- Findings provide insights for institutions evaluating or implementing CT-P/A for stroke assessment and thrombectomy workup.
Purpose:
Evaluate concordance of provider practices with clinical guidelines for thrombectomy screening in an emergency department (ED) via computed tomography perfusion and angiogram (CT-P/A).
Methods:
A retrospective observational study was conducted for patients 18 years or older who received a CT-P/A of the head and neck in a US Midwestern ED between September 2019 through June 2021. Healthcare system records reviewed for patient information, CT-P/A findings, and treatment decisions.
Results:
During study period, 68,403 patients presented to the ED with 718 (1.1%) receiving a CT-P/A. Of these patients, 105 (14.6%) were transferred to a regional facility for potential thrombectomy, with 74 (70.5%) receiving procedure, 28 (26.7%) not receiving procedure, and 3 (2.9%) with insufficient follow-up information. Of patients receiving CT-P/A, 23 met DAWN criteria for thrombectomy, with 21 (91.3%) transferred for potential thrombectomy and 20 (95.2%) receiving the procedure; in comparison, 81 patients (11.7%) did not meet all DAWN criteria and were transferred for potential thrombectomy, with 52 (64.2%) receiving procedure. Lastly, 55 patients met DEFUSE-3 criteria for thrombectomy with 49 (89.1%) being transferred for potential thrombectomy and 45 (91.8%) receiving procedure. In comparison, 53 patients who did not meet all DEFUSE-3 criteria were transferred for potential thrombectomy, with 27 (50.9%) receiving procedure.
Conclusions:
This study helps to understand CT-P/A usage, especially in patients that fall outside of treatment criteria in the current thrombectomy literature. Results may have value to institutions interested in using CT-P/A as a diagnostic tool as well as institutions already incorporating it in stroke assessments.
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