Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Neurology, Divisions of Cerebrovascular Disease, Critical Care and Neurotrauma, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
J Neurointerv Surg. 2018 Jan;10(1):22-24. doi: 10.1136/neurintsurg-2016-012854. Epub 2017 Jan 24.
Access to endovascular therapy (ET) in cases of acute ischemic stroke may be limited, and rapid transfer of eligible patients to hospitals with endovascular capability is needed.
To determine the optimal timing of diagnostic CT angiography to confirm large vessel occlusion (LVO).
Of 57 emergency department transfers to Mount Sinai Hospital (MSH) for possible ET from January 2015 through March 2016, 39 (68%) underwent ET, among whom 22 (56%) had CT angiography before transfer and 17 (44%) had CT angiography on arrival. We compared mean outside hospital arrival to groin puncture (OTG) time between the two groups using t-tests and Wilcoxon rank sum tests. OTG was defined as the difference between groin puncture and outside hospital arrival time minus ambulance travel time.
Average age was 73±13 years and average National Institute of Health Stroke Scale score was 19±5. There was no difference in average OTG time between the two groups (191 min for CT angiography at outside hospital vs 190 min for CT angiography at MSH (p=0.99 for t-test and 0.69 for rank sum test)). Among the 18 patients who were transferred but did not receive ET, 10 had no LVO, 5 had large established infarcts on arrival and 3 had post-tissue plasminogen activator hemorrhage. In 9/10 patients without LVO, CT angiography was not performed before transfer.
CT angiography timing in the transfer process does not affect OTG time, but 90% of patients without LVO had not had CT angiography before transfer. Hence, it might be beneficial to obtain a CT angiogram at the outside hospital, if it can be acquired and read rapidly, to avoid the cost and potential clinical deterioration associated with unnecessary transfers.
急性缺血性脑卒中患者接受血管内治疗（ET）的机会可能受限，需要迅速将符合条件的患者转送至有血管内治疗能力的医院。
确定诊断性 CT 血管造影以确认大血管闭塞（LVO）的最佳时机。
2015 年 1 月至 2016 年 3 月期间，共有 57 名从急诊转至西奈山医院（MSH）接受可能的 ET 的患者，其中 39 名（68%）接受了 ET，其中 22 名（56%）在转院前进行了 CT 血管造影，17 名（44%）在到达时进行了 CT 血管造影。我们使用 t 检验和 Wilcoxon 秩和检验比较了两组之间从院外到达股动脉穿刺（OTG）的平均时间。OTG 定义为股动脉穿刺与院外到达时间减去救护车行驶时间之间的差异。
平均年龄为 73±13 岁，平均 NIHSS 评分为 19±5。两组的平均 OTG 时间无差异（院外 CT 血管造影组为 191 分钟，MSH 组为 190 分钟（t 检验 p=0.99，秩和检验 p=0.69））。在 18 名未接受 ET 而被转院的患者中，10 名无 LVO，5 名到达时存在大的已建立的梗死，3 名存在组织型纤溶酶原激活剂后出血。在 10 名无 LVO 的患者中，有 9 名在转院前未进行 CT 血管造影。
转院过程中 CT 血管造影的时间并不影响 OTG 时间，但 90%无 LVO 的患者在转院前未进行 CT 血管造影。因此，如果能够快速获取和读取 CT 血管造影结果，在院外进行 CT 血管造影可能会有所裨益，以避免不必要的转院带来的成本和潜在的临床恶化。
