From the Department of Neurology (J.M.K., M.G.), Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
Department of Radiology (J.M.K., A.T.B., G.M., P.C.S.), Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
AJNR Am J Neuroradiol. 2021 Oct;42(10):1798-1806. doi: 10.3174/ajnr.A7227. Epub 2021 Aug 12.
Delays to reperfusion negatively impact outcomes of patients with ischemic stroke, yet current guidelines recommend selective sequential imaging for thrombectomy candidates. We aimed to quantify and analyze time delays associated with rescanning in sequential acute stroke imaging.
This was a retrospective cohort study of consecutive patients with acute ischemic stroke who underwent imaging for treatment decision-making from January 1, 2017, to June 30, 2020. Rescan time delay was defined as ≥10-minute difference between initial NCCT and CTA ± CTP. Mean rescan time delays in comprehensive and primary stroke centers were compared. Bivariate and multivariable regression analyses assessed clinical and imaging factors associated with rescanning time delays and early outcomes.
A total of 588 patients with acute ischemic were included in statistical analyses. Rescanning occurred in 27.9% (164/588 patients), with a mean time delay of 53.7 (SD, 43.4) minutes. For patients presenting at primary compared with comprehensive stroke centers, rescan time delays were more common (59.6% versus 11.8%, < .001), with longer delays (65.4 [SD, 45.4] minutes versus 23.6 [SD, 14.0] minutes, < .001). Independent predictors of rescan time delays included primary stroke center presentation, intravenous thrombolysis administration, black race, admission NIHSS ≥10, baseline independent ambulation, and onset-to-comprehensive stroke center arrival in ≥6 hours. Protocols for early simultaneous comprehensive CT (NCCT + CTA + CTP) were associated with lower odds of time delays (OR = 0.34; 95% CI, 0.21-0.55). Rescanning was associated with lower odds of home discharge (OR = 0.53; 95% CI, 0.30-0.95).
A sequential approach to CT-based imaging may be significantly associated with prolonged acute stroke evaluations. Adoption of early simultaneous comprehensive CT could minimize treatment delays and improve outcomes.
再灌注时间的延迟会对缺血性脑卒中患者的预后产生负面影响，但目前的指南建议对取栓候选者进行选择性连续影像学检查。我们旨在量化和分析连续急性脑卒中影像检查中重新扫描相关的时间延迟。
这是一项回顾性队列研究，纳入了 2017 年 1 月 1 日至 2020 年 6 月 30 日期间因治疗决策而接受影像学检查的连续急性缺血性脑卒中患者。重新扫描时间延迟定义为初始 NCCT 与 CTA±CTP 之间的差异≥10 分钟。比较综合和初级卒中中心的平均重新扫描时间延迟。采用双变量和多变量回归分析评估与重新扫描时间延迟和早期结局相关的临床和影像学因素。
共有 588 例急性缺血性脑卒中患者纳入统计学分析。27.9%（588 例患者中有 164 例）患者进行了重新扫描，平均时间延迟为 53.7（SD，43.4）分钟。与综合卒中中心相比，于初级卒中中心就诊的患者更常进行重新扫描（59.6%比 11.8%，<.001），且时间延迟更长（65.4[SD，45.4]分钟比 23.6[SD，14.0]分钟，<.001）。重新扫描时间延迟的独立预测因素包括：初级卒中中心就诊、静脉溶栓治疗、黑种人、入院 NIHSS≥10、基线独立行走、发病至综合卒中中心就诊时间≥6 小时。早期同时进行全面 CT（NCCT+CTA+CTP）的方案与时间延迟的可能性降低相关（OR=0.34；95%CI，0.21-0.55）。重新扫描与出院回家的可能性降低相关（OR=0.53；95%CI，0.30-0.95）。
基于 CT 的影像学连续检查可能与急性脑卒中评估时间的延长显著相关。采用早期同时进行全面 CT 可最大限度减少治疗延迟并改善结局。
