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  • 1
    Online Resource
    Online Resource
    One-Stop Management of Acute Stroke Patients : Minimizing Door-to-Reperfusion Times
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. 11 ( 2017-11), p. 3152-3155
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 11 ( 2017-11), p. 3152-3155
    Abstract: Intrahospital time delays significantly affect the neurological outcome of stroke patients with large-vessel occlusion. This study was conducted to determine whether a one-stop management can reduce intrahospital times of patients with acute large-vessel occlusion. Methods— In this observational study, we report the first 30 consecutive stroke patients imaged and treated in the same room. As part of our protocol, we transported patients with a National Institutes of Health Stroke Scale score of ≥10 directly to the angio suite, bypassing multidetector computed tomography (CT). Preinterventional imaging consisted of noncontrast flat detector CT and flat detector CT angiography, acquired with an angiography system. Patients with large-vessel occlusions remained on the angio table and were treated with mechanical thrombectomy; patients with small artery occlusions were treated with intravenous thrombolysis, whereas patients with an intracranial hemorrhage and stroke mimics were treated as per guidelines. Door-to-groin puncture times were recorded and compared with our past results. Results— Thirty patients were transferred directly to our angio suite from June to December 2016. The time from symptom onset to admission was 105 minutes. Ischemic stroke was diagnosed in 22 of 30 (73%) patients, 4 of 30 (13.5%) had an intracranial hemorrhage, and 4 of 30 (13.5) were diagnosed with a Todd’s paresis. Time from admission to groin puncture was 20.5 minutes. Compared with 44 patients imaged with multidetector CT in the first 6 months of 2016, door-to-groin times were significantly reduced (54.5 minutes [95% confidence interval, 47–61] versus 20.5 minutes [95% confidence interval, 17–26] ). Conclusions— In this small series, a one-stop management protocol of selected stroke patients using latest generation flat detector CT led to a significant reduction of intrahospital times.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.117.018077
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
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  • 2
    Online Resource
    Online Resource
    Abstract 117: One Stop Management of Acute Stroke Patients: Minimizing Door to Groin Times and Improving Functional Outcome
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. Suppl_1 ( 2018-01-22)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. Suppl_1 ( 2018-01-22)
    Abstract: 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.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.117
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1467823-8
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  • 3
    Online Resource
    Online Resource
    Abstract TP31: High Systolic Blood Pressure After Successful Endovascular Treatment Affects Functional Outcome in Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. Suppl_1 ( 2018-01-22)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. Suppl_1 ( 2018-01-22)
    Abstract: Background: Endovascular treatment (EVT) has been shown to significantly improve functional outcome in patients with acute large cerebral vessel occlusions. To date, no evidence based recommendations on blood pressure management after successful EVT exist. Previous studies showed an association between high pre-EVT systolic blood pressure (SBP) and functional outcome, but do not answer the question on how to manage blood pressure after successful recanalization. Methods: Prospectively derived data from patients with acute large vessel occlusion within the anterior circulation and EVT was analyzed in this monocentric study. Mean systolic- and maximum SBP as well as SBP-peaks have been obtained for the first 24 hours after successful EVT. Predictive value of SBP for discharge National Institute of Health Stroke Scale (NIHSS)-reduction of ≥50% and discharge modified Rankin scale (mRS) ≤2 has been investigated using logistic regression models and Receiver Operating Characteristic Curve analysis. Results: From 168 patients with successful EVT, 95 (56.5%) had favorable NIHSS-based- and 74 (44%) a favorable mRS-based outcome. Mean- (NIHSS-group: 127 vs 132 mmHg, p=0.024; mRS-group: 127 vs 131 mmHg, p=0.035) and maximum SBP (NIHSS-group: 159 vs 170 mmHg, p 〈 0.001; mRS-group: 157 vs 169 mmHg, p 〈 0.001) as well as number of SBP peaks (NIHSS-group: 0 vs 2, p=0.003; mRS-group: 0 vs 1.5, p=0.004) were lower in patients with favorable outcome. Multivariable logistic regression showed high SBP to predict unfavorable outcome. Cut-off mean SBP was 140.5 mmHg and maximum SBP 159 mmHg. Maier et al., Systolic blood pressure and outcome after EVT, abstract page 2 Conclusions: High SBP in the first 24 hours after recanalization of acute anterior cerebral vessel occlusions is associated with unfavorable functional outcome. Interventional studies are needed to determine the role of SBP management as a modifiable parameter in the early phase after successful EVT.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.TP31
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1467823-8
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  • 4
    Online Resource
    Online Resource
    Abstract WMP13: Latest Generation of Flat Detector CT as a Periinterventional Diagnostic Tool: A Comparative Study with Multidetector CT
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. suppl_1 ( 2017-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. suppl_1 ( 2017-02)
    Abstract: Background and Purpose: Flat detector CT has been used as a periinterventional 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 flat detector CT to a standard multidetector CT. Materials and Methods: One hundred and two patients were included in our retrospective study. All patients had undergone interventional procedures; flat detector CT was acquired periinterventionally and compared to a postinterventional multidetector CT regarding the depiction of ventricular/subarachnoidal spaces, the detection of intracranial hemorrhage and the delineation of ischemic lesions by using an ordinal scale. Ischemic lesions were quantified with the Alberta Stroke Program Early CT score on both exams. Two neuroradiologists of various experience grades and a medical student scored the anonymized images, blinded to clinical history. Results: The two methods were diagnostic equal in evaluating the ventricular system and the subarachnoidal spaces. Subarachnoidal, intraventicular and intraparenchymal hemorrhages were detected with a sensitivity of 95%, 94%, 100% and specificity of 97%, 97% and 99% respectively using flat detector CT. Grey-white differentiation was feasible in the majority of flat detector CT scans and ischemic lesions were detected with a sensitivity of 71% on flat detector CT, compared to multidetector CT scans. Alberta Stroke Program Early CT score values correlated highly with a correlation coefficient of r=0,78. Conclusion: The latest generation of flat detector CT is a reliable tool for the detection of intracranial hemorrhage and extended ischemic lesions. Flat detector CT acquired with angiography systems could be increasingly used in acute stroke diagnostics (so called one stop imaging) with a massive impact in door to groin times.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.48.suppl_1.wmp13
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
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  • 5
    Online Resource
    Online Resource
    Abstract TP242: Optimization of In-hospital Workflow of Acute Stroke Patients
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Introduction: Time from symptom onset to recanalization and especially from admission to recanalization are important factors in the treatment of acute stroke patients with large vessel occlusion. Hypothesis: Frequent team meetings between neurologists, neuroradiologists and anesthesiologists as well as a new interdisciplinary standard operating procedure (SOP) would lead to a significant reduction of time from admission to recanalization in treating acute stroke patients. A shift to better clinical outcomes would be documented after implementation of the new SOP. Methods: Data were extracted from a prospectively documented university hospital stroke database. 315 patients were divided into a) 242 patients treated with mechanical thrombectomy prior to the new SOP from 2007 until 2013 and b) 73 patients treated with mechanical thrombectomy after implementation of the new SOP from 2014 to now. Results: Symptom onset to admission time was not statistically significant between the two groups. Time from admission to groin puncture was massively reduced from 120 to 65 minutes after implementation of the new SOP (P 〈 0,0001). Groin to recanalization time was also significantly reduced (P=0,0011). The use of a stent retriever was not a significant factor in reducing times from groin puncture to recanalization. Implementation of the new SOP led to a significant shift of clinical outcomes after mechanical thrombectomy. Conclusions: Interdisciplinary team work and implementation of a new SOP led to a significant reduction of in-hospital examination, transportation, imaging and treatment times in our stroke center. Better clinical outcomes were reported with faster treatment times.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.tp242
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
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    Online Resource
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