From the Department of Neurology (C.Z.S., K.E.S., G.A.)
Division of Neurointervention, Texas Stroke Institute, Dallas-Fort Worth (A.J.Y.).
Stroke. 2018 Jun;49(6):1402-1406. doi: 10.1161/STROKEAHA.118.021038. Epub 2018 May 8.
The GOLIATH trial (General or Local Anesthesia in Intra-Arterial Therapy) compared infarct growth and outcome in patients undergoing endovascular therapy under either general anesthesia or conscious sedation. Magnetic resonance imaging was performed before and after the procedure to study infarct growth. In this post hoc analysis of GOLIATH, we aimed to characterize the workflow of patients undergoing magnetic resonance imaging selection before endovascular therapy.
We randomized 128 patients with anterior circulation large vessel occlusion stroke within 6 hours of onset to either general anesthesia or conscious sedation (1:1 allocation). We studied workflow time intervals to examine whether magnetic resonance imaging conferred a time delay in treatment when compared with computed tomography-based studies that emphasized rapid workflow.
Of 128 patients enrolled between March 2015 and February 2017, 65 were randomized to general anesthesia. Baseline demographic and clinical variables were balanced between the treatment arms. The median interval from scan to groin puncture was 56.5 minutes (interquartile range, 44.5-73.5) for all patients. The median interval from admission to groin puncture was 68 minutes (interquartile range, 54.5-87 minutes). Comparable intervals in recent randomized data were 51 minutes (interquartile range, 39-68) for scan to groin puncture in the ESCAPE trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times) and 90 minutes (interquartile range, 69-120 minutes) for door to groin puncture in the SWIFT-PRIME study (Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment).
Workflow in GOLIATH demonstrates that magnetic resonance imaging selection for endovascular therapy can be accomplished rapidly and within a similar time frame as computed tomography-based selection.
URL: https://www.clinicaltrials.gov. Unique identifier: NCT02317237.
GOLIATH 试验（全身麻醉与局部麻醉在动脉内治疗中的比较）比较了发病 6 小时内接受血管内治疗的患者在全身麻醉或清醒镇静下的梗死进展和结局。在治疗前和治疗后进行磁共振成像（MRI）以研究梗死进展。在 GOLIATH 的这项事后分析中，我们旨在描述血管内治疗前接受 MRI 选择的患者的工作流程。
我们将 128 例发病 6 小时内的前循环大血管闭塞性卒中患者随机分为全身麻醉组或清醒镇静组（1:1 分配）。我们研究了工作流程时间间隔，以检查 MRI 是否与强调快速工作流程的基于计算机断层扫描（CT）的研究相比导致了治疗时间延迟。
2015 年 3 月至 2017 年 2 月期间共纳入 128 例患者，其中 65 例随机分配至全身麻醉组。治疗组之间的基线人口统计学和临床变量平衡。所有患者的从扫描到腹股沟穿刺的中位时间间隔为 56.5 分钟（四分位距，44.5-73.5）。从入院到腹股沟穿刺的中位时间间隔为 68 分钟（四分位距，54.5-87 分钟）。最近的随机数据中类似的时间间隔为 ESCAPE 试验（小核心和前循环近端闭塞的血管内治疗，强调最小化 CT 再通时间）中扫描至腹股沟穿刺的 51 分钟（四分位距，39-68 分钟）和 SWIFT-PRIME 研究（Solitaire 伴血栓切除术作为主要血管内治疗的意图）中门至腹股沟穿刺的 90 分钟（四分位距，69-120 分钟）。
GOLIATH 的工作流程表明，血管内治疗的 MRI 选择可以快速完成，并且与基于 CT 的选择在类似的时间范围内完成。
