一站式灌注管理治疗因大血管闭塞导致的卒中转移患者：可行性和对住院时间的影响。
One-Stop Management with Perfusion for Transfer Patients with Stroke due to a Large-Vessel Occlusion: Feasibility and Effects on In-Hospital Times.
机构信息
From the Departments of Neuroradiology (A.B., I.T., H.J.E., M.-N.P.)
Department of Neuroradiology (A.B., I.T., M.-N.P.), Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
出版信息
AJNR Am J Neuroradiol. 2019 Aug;40(8):1330-1334. doi: 10.3174/ajnr.A6129. Epub 2019 Jul 11.
BACKGROUND AND PURPOSE
In-hospital time delays lead to a relevant deterioration of neurologic outcomes in patients with stroke with large-vessel occlusions. At the moment, CT perfusion is relevant in the triage of late-window patients with stroke. We conducted this study to determine whether one-stop management with perfusion is feasible and leads to a reduction of in-hospital times.
MATERIALS AND METHODS
In this observational study, we report the first 15 consecutive transfer patients with stroke with externally confirmed large-vessel occlusions who underwent flat panel detector CT perfusion and thrombectomy in the same room. Preinterventional imaging consisted of noncontrast flat panel detector CT and flat panel detector CT perfusion, acquired with a biplane angiography system. The flat panel detector CT perfusion was used to reconstruct a flat panel detector CT angiography to confirm the large-vessel occlusions. After confirmation of the large-vessel occlusion, the patient underwent mechanical thrombectomy. We recorded time metrics and safety parameters prospectively and compared them with those of transfer patients whom we treated before the introduction of one-stop management with perfusion.
RESULTS
Fifteen transfer patients underwent flat panel detector CT perfusion and were treated with mechanical thrombectomy from June 2017 to January 2019. The median time from symptom onset to admission was 241 minutes. Median door-to-groin time was 24 minutes. Compared with 23 transfer patients imaged with multidetector CT, it was reduced significantly (24 minutes; 95% CI, 19-37 minutes, versus 53 minutes; 95% CI, 44-66 minutes; < .001). Safety parameters were comparable between groups.
CONCLUSIONS
In this small series, one-stop management with perfusion led to a significant reduction of in-hospital times compared with our previous workflow.
背景与目的
在有大血管闭塞的卒中患者中，院内时间延迟会导致神经功能恶化。目前，CT 灌注在卒中晚期患者的分诊中具有重要意义。我们进行这项研究是为了确定是否可以进行一站式灌注管理，以及是否可以减少住院时间。
材料与方法
在这项观察性研究中，我们报告了前 15 例连续的转院卒中患者，他们经外部证实有大血管闭塞，在同一个房间内接受了平板探测器 CT 灌注和血栓切除术。介入前的影像学检查包括非对比平板探测器 CT 和平板探测器 CT 灌注，使用双平面血管造影系统采集。平板探测器 CT 灌注用于重建平板探测器 CT 血管造影，以确认大血管闭塞。在确认大血管闭塞后，患者接受机械血栓切除术。我们前瞻性地记录时间指标和安全性参数，并将其与我们在引入一站式灌注管理之前治疗的转院患者进行比较。
结果
15 例转院患者接受了平板探测器 CT 灌注，并在 2017 年 6 月至 2019 年 1 月期间接受了机械血栓切除术。从发病到入院的中位数时间为 241 分钟。门到腹股沟时间的中位数为 24 分钟。与 23 例接受多排 CT 成像的转院患者相比，这一时间明显缩短（24 分钟；95%CI，19-37 分钟，而 53 分钟；95%CI，44-66 分钟；<0.001）。两组的安全性参数相当。
结论
在这项小系列研究中，与我们之前的工作流程相比，一站式灌注管理显著缩短了住院时间。
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