1. The Yield of Multimodal Computed Tomography among Emergency Department Patients with Suspected Large Vessel Occlusion Stroke.
- Author
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Dastmalchi YS and Oostema JA
- Subjects
- Aged, Aged, 80 and over, Brain Ischemia physiopathology, Brain Ischemia therapy, Carotid Stenosis physiopathology, Carotid Stenosis therapy, Clinical Decision-Making, Endovascular Procedures, Female, Humans, Male, Middle Aged, Patient Selection, Predictive Value of Tests, Retrospective Studies, Stroke physiopathology, Stroke therapy, Treatment Outcome, Brain Ischemia diagnostic imaging, Carotid Stenosis diagnostic imaging, Cerebral Angiography methods, Computed Tomography Angiography, Emergency Service, Hospital, Perfusion Imaging methods, Stroke diagnostic imaging
- Abstract
Objectives: Endovascular therapy (EVT) improves outcomes for appropriately selected acute ischemic stroke patients. Guidelines suggest rapid acquisition of noninvasive vascular imaging to screen suspected ischemic stroke patients for large vessel occlusion (LVO) and candidacy for EVT. We sought to quantify the yield of an LVO stroke screening process in an undifferentiated emergency department (ED) suspected stroke population as well as identify predictors of successful EVT., Methods: We identified a cohort of consecutive ED patients who received CT angiography and brain perfusion (CTA/P) imaging to determine candidacy for EVT during 2016. In keeping with the guidelines at that time, hospital protocol directed physicians to obtain CTA/P studies if time from the onset of symptoms was less than or equal to 6 hours, and the National Institute of Health Stroke Scale (NIHSS) more than or equal to 6 or if recommended by the consulting stroke neurologist. Final discharge diagnoses, EVT attempts, and successful reperfusion (TICI 2b or better) were recorded. Yield of CTA/P was compared among patients based on NIHSS and duration of symptoms., Results: Over a 12-month period, 406 suspected stroke patients were screened with CTA/P; 273 (67%) received a final diagnosis of ischemic stroke. Among cases screened, 53 (13%) underwent attempted EVT; 35 (9%) achieved successful reperfusion. Only 1 of 113 (1%) patients with an NIHSS less than 6 was successfully treated with EVT compared to 34 of 285 (12%) with higher NIHSS (p = 0.001). The probability of successful EVT declined with increasing symptom duration (p = 0.009 for trend). In multivariable analysis, NIHSS more than or equal to 6 was associated with successful EVT (odds ratio [OR] 4.0 [1.6 to 9.9]) but presentation within 6 hours of onset was not (OR 2.3 [0.8 to 6.7])., Conclusions: EVT candidates were common among suspected stroke patients screened with CTA/P in the ED, however, patients with NIHSS less than 6 rarely received successful EVT., (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Published
- 2019
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