Timing of vessel imaging for suspected large vessel occlusions does not affect groin puncture time in transfer patients with stroke.

Authors

John W. Liang, Thomas Jefferson UniversityFollow
Laura Stein, Icahn School of Medicine at Mount SinaiFollow
Natalie Wilson, Icahn School of Medicine at Mount SinaiFollow
Johanna T. Fifi, Icahn School of Medicine at Mount Sinai
Stanley Tuhrim, Icahn School of Medicine at Mount Sinai
Mandip S. Dhamoon, Icahn School of Medicine at Mount SinaiFollow

Document Type

Article

Publication Date

1-1-2018

Comments

This article has been peer reviewed. It is the authors' final version prior to publication in Journal of NeuroInterventional Surgery

Volume 10, Issue 1, January 2017, Pages 22-24.

The published version is available at DOI: 10.1136/neurintsurg-2016-012854. Copyright © BMJ Publishing Group Limited

Abstract

BACKGROUND: 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.

OBJECTIVE: To determine the optimal timing of diagnostic CT angiography to confirm large vessel occlusion (LVO).

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Recommended Citation

Liang, John W.; Stein, Laura; Wilson, Natalie; Fifi, Johanna T.; Tuhrim, Stanley; and Dhamoon, Mandip S., "Timing of vessel imaging for suspected large vessel occlusions does not affect groin puncture time in transfer patients with stroke." (2018). Department of Neurology Faculty Papers. Paper 147.
https://jdc.jefferson.edu/neurologyfp/147

PubMed ID

28119375