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One-Stop Management of Acute Stroke Patients: Minimizing Door-to-Reperfusion Times.

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.
PMID
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Authors

Mayor MeshTerms

Cerebral Angiography

Intracranial Hemorrhages

Patient Admission

Stroke

Tomography, X-Ray Computed

Keywords

cerebral angiography

cerebral hemorrhage

cone-beam computed tomography

stroke

thrombectomy

Journal Title stroke
Publication Year Start




PMID- 29018132
OWN - NLM
STAT- MEDLINE
DCOM- 20171026
LR  - 20171026
IS  - 1524-4628 (Electronic)
IS  - 0039-2499 (Linking)
VI  - 48
IP  - 11
DP  - 2017 Nov
TI  - One-Stop Management of Acute Stroke Patients: Minimizing Door-to-Reperfusion
      Times.
PG  - 3152-3155
LID - 10.1161/STROKEAHA.117.018077 [doi]
AB  - BACKGROUND AND PURPOSE: 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.
CI  - (c) 2017 American Heart Association, Inc.
FAU - Psychogios, Marios-Nikos
AU  - Psychogios MN
AD  - From the Department of Neuroradiology (M.N.P., D.B., K.S., I.T., J.R.L., J.T.,
      M.K.), Neurology (I.L.M., M.B., J.L.), and Medical Statistics (A.Z.), University 
      Medical Center Gottingen, Germany; and Department of Radiology, Brigham and
      Women's Hospital, Harvard Medical School, Boston, MA (K.S.).
      [email protected]
FAU - Behme, Daniel
AU  - Behme D
AD  - From the Department of Neuroradiology (M.N.P., D.B., K.S., I.T., J.R.L., J.T.,
      M.K.), Neurology (I.L.M., M.B., J.L.), and Medical Statistics (A.Z.), University 
      Medical Center Gottingen, Germany; and Department of Radiology, Brigham and
      Women's Hospital, Harvard Medical School, Boston, MA (K.S.).
FAU - Schregel, Katharina
AU  - Schregel K
AD  - From the Department of Neuroradiology (M.N.P., D.B., K.S., I.T., J.R.L., J.T.,
      M.K.), Neurology (I.L.M., M.B., J.L.), and Medical Statistics (A.Z.), University 
      Medical Center Gottingen, Germany; and Department of Radiology, Brigham and
      Women's Hospital, Harvard Medical School, Boston, MA (K.S.).
FAU - Tsogkas, Ioannis
AU  - Tsogkas I
AD  - From the Department of Neuroradiology (M.N.P., D.B., K.S., I.T., J.R.L., J.T.,
      M.K.), Neurology (I.L.M., M.B., J.L.), and Medical Statistics (A.Z.), University 
      Medical Center Gottingen, Germany; and Department of Radiology, Brigham and
      Women's Hospital, Harvard Medical School, Boston, MA (K.S.).
FAU - Maier, Ilko L
AU  - Maier IL
AD  - From the Department of Neuroradiology (M.N.P., D.B., K.S., I.T., J.R.L., J.T.,
      M.K.), Neurology (I.L.M., M.B., J.L.), and Medical Statistics (A.Z.), University 
      Medical Center Gottingen, Germany; and Department of Radiology, Brigham and
      Women's Hospital, Harvard Medical School, Boston, MA (K.S.).
FAU - Leyhe, Johanna Rosemarie
AU  - Leyhe JR
AD  - From the Department of Neuroradiology (M.N.P., D.B., K.S., I.T., J.R.L., J.T.,
      M.K.), Neurology (I.L.M., M.B., J.L.), and Medical Statistics (A.Z.), University 
      Medical Center Gottingen, Germany; and Department of Radiology, Brigham and
      Women's Hospital, Harvard Medical School, Boston, MA (K.S.).
FAU - Zapf, Antonia
AU  - Zapf A
AD  - From the Department of Neuroradiology (M.N.P., D.B., K.S., I.T., J.R.L., J.T.,
      M.K.), Neurology (I.L.M., M.B., J.L.), and Medical Statistics (A.Z.), University 
      Medical Center Gottingen, Germany; and Department of Radiology, Brigham and
      Women's Hospital, Harvard Medical School, Boston, MA (K.S.).
FAU - Tran, Julia
AU  - Tran J
AD  - From the Department of Neuroradiology (M.N.P., D.B., K.S., I.T., J.R.L., J.T.,
      M.K.), Neurology (I.L.M., M.B., J.L.), and Medical Statistics (A.Z.), University 
      Medical Center Gottingen, Germany; and Department of Radiology, Brigham and
      Women's Hospital, Harvard Medical School, Boston, MA (K.S.).
FAU - Bahr, Mathias
AU  - Bahr M
AD  - From the Department of Neuroradiology (M.N.P., D.B., K.S., I.T., J.R.L., J.T.,
      M.K.), Neurology (I.L.M., M.B., J.L.), and Medical Statistics (A.Z.), University 
      Medical Center Gottingen, Germany; and Department of Radiology, Brigham and
      Women's Hospital, Harvard Medical School, Boston, MA (K.S.).
FAU - Liman, Jan
AU  - Liman J
AD  - From the Department of Neuroradiology (M.N.P., D.B., K.S., I.T., J.R.L., J.T.,
      M.K.), Neurology (I.L.M., M.B., J.L.), and Medical Statistics (A.Z.), University 
      Medical Center Gottingen, Germany; and Department of Radiology, Brigham and
      Women's Hospital, Harvard Medical School, Boston, MA (K.S.).
FAU - Knauth, Michael
AU  - Knauth M
AD  - From the Department of Neuroradiology (M.N.P., D.B., K.S., I.T., J.R.L., J.T.,
      M.K.), Neurology (I.L.M., M.B., J.L.), and Medical Statistics (A.Z.), University 
      Medical Center Gottingen, Germany; and Department of Radiology, Brigham and
      Women's Hospital, Harvard Medical School, Boston, MA (K.S.).
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
DEP - 20171010
PL  - United States
TA  - Stroke
JT  - Stroke
JID - 0235266
SB  - IM
MH  - Acute Disease
MH  - *Cerebral Angiography
MH  - Female
MH  - Humans
MH  - *Intracranial Hemorrhages/diagnostic imaging/therapy
MH  - Male
MH  - *Patient Admission
MH  - Prospective Studies
MH  - *Stroke/diagnosis/therapy
MH  - Time Factors
MH  - *Tomography, X-Ray Computed
OTO - NOTNLM
OT  - cerebral angiography
OT  - cerebral hemorrhage
OT  - cone-beam computed tomography
OT  - stroke
OT  - thrombectomy
EDAT- 2017/10/12 06:00
MHDA- 2017/10/27 06:00
CRDT- 2017/10/12 06:00
PHST- 2017/05/17 00:00 [received]
PHST- 2017/08/31 00:00 [revised]
PHST- 2017/08/31 00:00 [accepted]
PHST- 2017/10/12 06:00 [pubmed]
PHST- 2017/10/27 06:00 [medline]
PHST- 2017/10/12 06:00 [entrez]
AID - STROKEAHA.117.018077 [pii]
AID - 10.1161/STROKEAHA.117.018077 [doi]
PST - ppublish
SO  - Stroke. 2017 Nov;48(11):3152-3155. doi: 10.1161/STROKEAHA.117.018077. Epub 2017
      Oct 10.