Chakraborty Santanu, Ross James, Hogan Mathew J, Dowlatshahi Dar, Stotts Grant
Division of Neuroradiology, Department of Medical Imaging, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada.
Division of Neuroradiology, Department of Medical Imaging, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada.
J Stroke Cerebrovasc Dis. 2015 Jun;24(6):1270-5. doi: 10.1016/j.jstrokecerebrovasdis.2015.01.039. Epub 2015 Apr 20.
The effectiveness of intravenous tissue plasminogen activator in the management of acute ischemic strokes diminishes significantly with time. Advanced computed tomography (CT) imaging can be helpful to identify candidates for neurointerventional procedures. We have successfully used a 320-slice Toshiba volume CT scanner since mid-2008. Other centers have forgone advanced imaging because of concerns of time delay. This study is to assess the time delay while using this scanner compared with our 64-slice scanner.
Treatment times of patients scanned with advanced imaging (CT head, dynamic CT angiography, and whole brain perfusion-group A) and patients scanned in a 64-slice scanner (CT head and traditional CT angiogram-group B) were compared. Two groups of stroke patients from November-March 2009-2010 (group 1) and 2012-2013 (group 2) were audited to assess temporal improvement. Multiple timing variables were analyzed.
One hundred fifty-three cases from 2009/10 and 192 cases from 2012/13 were analyzed. The median door-to-needle time (DNT) for group 1A and group 2A was 57 minutes and 47 minutes, respectively. The median DNT for group 1B and group 2B was 54 minutes and 49 minutes, respectively. Decrease in the overall DNT with group A can be attributed to the "streamlining" of the stroke code process. There was no difference in the DNT for patients who presented during working hours versus those who presented during nonworking hours.
With adequate experience and training, advanced stroke imaging with whole brain perfusion/dynamic CT angiography can be performed with treatment times that are comparable with traditional CT scanning.
静脉注射组织型纤溶酶原激活剂治疗急性缺血性卒中的有效性会随着时间显著降低。先进的计算机断层扫描（CT）成像有助于识别适合神经介入治疗的患者。自2008年年中以来，我们成功使用了一台320层东芝容积CT扫描仪。由于担心时间延迟，其他中心放弃了先进成像检查。本研究旨在评估使用该扫描仪与我们的64层扫描仪相比的时间延迟情况。
比较了接受先进成像检查（头颅CT、动态CT血管造影和全脑灌注——A组）的患者与在64层扫描仪上进行扫描（头颅CT和传统CT血管造影——B组）的患者的治疗时间。对2009年11月至2010年3月（第1组）和2012年至2013年（第2组）的两组卒中患者进行审核，以评估时间上的改善情况。分析了多个时间变量。
分析了2009/10年的153例病例和2012/13年的192例病例。1A组和2A组的中位门到针时间（DNT）分别为57分钟和47分钟。1B组和2B组的中位DNT分别为54分钟和49分钟。A组总体DNT的缩短可归因于卒中编码流程的“简化”。工作时间就诊的患者与非工作时间就诊的患者的DNT没有差异。
有了足够的经验和培训，采用全脑灌注/动态CT血管造影的先进卒中成像检查的治疗时间可与传统CT扫描相当。
