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  • 1
    Online Resource
    Online Resource
    One-Stop Management of 230 Consecutive Acute Stroke Patients: Report of Procedural Times and Clinical Outcome
    MDPI AG ; 2019
    In:  Journal of Clinical Medicine Vol. 8, No. 12 ( 2019-12-11), p. 2185-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 8, No. 12 ( 2019-12-11), p. 2185-
    Abstract: 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.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm8122185
    Language: English
    Publisher: MDPI AG
    Publication Date: 2019
    detail.hit.zdb_id: 2662592-1
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  • 2
    Online Resource
    Online Resource
    Latest generation of flat detector CT as a peri-interventional diagnostic tool: a comparative study with multidetector CT
    BMJ ; 2017
    In:  Journal of NeuroInterventional Surgery Vol. 9, No. 12 ( 2017-12), p. 1253-1257
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 9, No. 12 ( 2017-12), p. 1253-1257
    Abstract: Flat detector CT (FDCT) has been used as a peri-interventional diagnostic tool in numerous studies with mixed results regarding image quality and detection of intracranial lesions. We compared the diagnostic aspects of the latest generation FDCT with standard multidetector CT (MDCT). Materials and methods 102 patients were included in our retrospective study. All patients had undergone interventional procedures. FDCT was acquired peri-interventionally and compared with postinterventional MDCT regarding depiction of ventricular/subarachnoidal spaces, detection of intracranial hemorrhage, and delineation of ischemic lesions using an ordinal scale. Ischemic lesions were quantified with the Alberta Stroke Program Early CT Scale (ASPECTS) on both examinations. Two neuroradiologists with varying grades of experience and a medical student scored the anonymized images separately, blinded to the clinical history. Results The two methods were of equal diagnostic value regarding evaluation of the ventricular system and the subarachnoidal spaces. Subarachnoidal, intraventricular, and parenchymal hemorrhages were detected with a sensitivity of 95%, 97%, and 100% and specificity of 97%, 100%, and 99%, respectively, using FDCT. Gray–white differentiation was feasible in the majority of FDCT scans, and ischemic lesions were detected with a sensitivity of 71% on FDCT, compared with MDCT scans. The mean difference in ASPECTS values on FDCT and MDCT was 0.5 points (95% CI 0.12 to 0.88). Conclusions The latest generation of FDCT is a reliable and accurate tool for the detection of intracranial hemorrhage. Gray–white differentiation is feasible in the supratentorial region.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2016-012866
    Language: English
    Publisher: BMJ
    Publication Date: 2017
    detail.hit.zdb_id: 2506028-4
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  • 3
    Online Resource
    Online Resource
    Abstract TMP3: One-stop Management of 230 Consecutive Acute Stroke Patients Report of Procedural Times and Clinical Outcome
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. Suppl_1 ( 2020-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. Suppl_1 ( 2020-02)
    Abstract: Introdruction: 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 hours 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 (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.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.51.suppl_1.TMP3
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 1467823-8
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  • 4
    Online Resource
    Online Resource
    Computed tomography perfusion-based selection of endovascularly treated acute ischaemic stroke patients – Are there lessons to be learned from the pre-evidence era?
    SAGE Publications ; 2017
    In:  The Neuroradiology Journal Vol. 30, No. 2 ( 2017-04), p. 138-143
    Details
    In: The Neuroradiology Journal, SAGE Publications, Vol. 30, No. 2 ( 2017-04), p. 138-143
    Abstract: Some of the latest groundbreaking trials suggest that noncontrast cranial computed tomography and computed tomography-angiography are sufficient tools for patient selection within six hours of symptom onset. Before endovascular stroke therapy became the standard of care, patient selection was one of the most useful tools to avoid futile reperfusions. We report the outcomes of endovascularly treated stroke patients selected with a perfusion-based paradigm and discuss the implications in the current era of endovascular treatment. Material and methods After an interdisciplinary meeting in September 2012 we agreed to select thrombectomy candidates primarily based on computed tomography perfusion with a cerebral blood volume Alberta Stroke Program Early Computed Tomography Scale (CBV-ASPECTS) of 〈 7 being a strong indicator of futile reperfusion. In this study, we retrospectively screened all patients with an M1 thrombosis in our neurointerventional database between September 2012 and December 2014. Results In 39 patients with a mean age of 69 years and a median admission National Institute of Health Stroke Scale of 17 the successful reperfusion rate was 74% and the favourable outcome rate at 90 days was 56%. Compared to previously published data from our database 2007–2011, we found that a two-point increase in median CBV-ASPECTS was associated with a significant increase in favourable outcomes. Conclusion Computed tomography perfusion imaging as an additional selection criterion significantly increased the rate of favourable clinical outcome in patients treated with mechanical thrombectomy. Although computed tomography perfusion has lost impact within the six-hour period, we still use it in cases beyond six hours as a means to broaden the therapeutic window.
    Type of Medium: Online Resource
    ISSN: 1971-4009 , 2385-1996
    URL: Article
    DOI: 10.1177/1971400916689372
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 2622347-8
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