Vagal Achala, Meganathan Karthikeyan, Kleindorfer Dawn O, Adeoye Opeolu, Hornung Richard, Khatri Pooja
From the Departments of Radiology (A.V.), Neurology (D.O.K., R.H., P.K.), Emergency Medicine (O.A.), and Family Medicine (K.M.), University of Cincinnati Medical Center, OH.
Stroke. 2014 Apr;45(4):1029-34. doi: 10.1161/STROKEAHA.113.004332. Epub 2014 Feb 25.
Our objective was to study nationwide utilization trends of computed tomographic (CT) angiogram (CTA) and CT perfusion (CTP) in acute ischemic stroke and particularly in the context of use of reperfusion therapies.
We reviewed the Premier Perspective Database for ischemic stroke-related hospitalizations of adult patients during a 5-year period, 2006 to 2010. Use of multimodal CT-based imaging and reperfusion therapies was determined through the procedure and billing codes. Logistic regression was used to identify predictors of utilization of imaging studies and reperfusion treatments.
An increasing proportion of ischemic strokes received CTA each year: 3.8% in 2006, 5.6% in 2007, 6.5% in 2008, 7.5% in 2009, and 9.1% in 2010 (P<0.0001). The proportion of acute strokes that were imaged with CTP imaging also increased each year: 0.05% in 2006, 0.05% in 2007, 0.9% in 2008, 2.2% in 2009, and 2.9% in 2010 (P<0.0001). Reperfusion treatment was more common among those who were imaged with CTA (13.0%) and CTP (17.6%) compared with those with CT head alone (4.0%; P<0.0001). Specifically, higher rates of recombinant tissue-type plasminogen activator were observed in CTA (10.2%) and CTP (11.4%) compared with those with CT head alone (3.8%; P<0.0001). Similarly, higher rates of mechanical embolectomy were observed in CTA (2.8%) and CTP (6.3%) compared with those with CT head alone (0.2%; P<0.0001).
There was a marked increase in the rate of CTA and CTP studies in setting of acute ischemic stroke from 2006 to 2010, and both modalities were associated with increased reperfusion therapy use.
我们的目的是研究全国范围内计算机断层扫描（CT）血管造影（CTA）和CT灌注（CTP）在急性缺血性卒中中的应用趋势，尤其是在再灌注治疗使用的背景下。
我们回顾了2006年至2010年5年间Premier Perspective数据库中成年患者缺血性卒中相关住院情况。通过手术和计费代码确定基于多模态CT成像和再灌注治疗的使用情况。使用逻辑回归来确定成像研究和再灌注治疗使用的预测因素。
每年接受CTA检查的缺血性卒中比例不断增加：2006年为3.8%，2007年为5.6%，2008年为6.5%，2009年为7.5%，2010年为9.1%（P<0.0001）。接受CTP成像的急性卒中比例也逐年增加：2006年为0.05%，2007年为0.05%，2008年为0.9%，2009年为2.2%，2010年为2.9%（P<0.0001）。与仅接受头颅CT检查的患者（4.0%；P<0.0001）相比，接受CTA（13.0%）和CTP（17.6%）成像的患者中再灌注治疗更为常见。具体而言，与仅接受头颅CT检查的患者（3.8%；P<0.0001）相比，CTA组（10.2%）和CTP组（11.4%）观察到更高的重组组织型纤溶酶原激活剂使用率。同样，与仅接受头颅CT检查的患者（0.2%；P<0.0001）相比，CTA组（2.8%）和CTP组（6.3%）观察到更高的机械取栓率。
2006年至2010年急性缺血性卒中患者中CTA和CTP检查率显著增加，且这两种检查方式均与再灌注治疗使用率增加相关。
