Vascular Imaging Before Intravenous Thrombolysis: Consequences of In‐Hospital Delay in Applying Two Diagnostic Procedures

Abstract

Performing CTA before IVT seems to increase door-to-needle time. Vascular imaging based on DUS should be considered only if this does not lead to in-hospital delay.

Factors affecting in-hospital delay of intravenous thrombolysis for acute ischemic stroke

“…[3] The level of NIHSS score can reflect the clinical situation of the patient more intuitively. [17,18] This study shows that patients with higher admission NIHSS scores have a lower risk of in-hospital delays, which might be explained by that fact that severe clinical symptoms easily attracted the family members and emergency medicine specialist and specialist physicians. Namely, the patients who have higher NIHSS score underwent quick inspections after they arrived at hospital and the green channel in hospital for AIS closely connected all stroke units, which reduced hospital transit time and the risk of in-hospital delays.…”

Identificación de los factores que influyen en el retraso intrahospitalario del inicio de trombólisis intravenosa en el ictus agudo en un hospital terciario

“…Se han obtenido resultados similares en estudios previos 6,7,20 . La realización de pruebas de imagen avanzada como la angio-TC y la TC de perfusión pueden ser útiles en la selección de pacientes candidatos a otras terapias recanalizadoras distintas de la TIV, como la extracción mecánica del trombo o la trombólisis intraarterial.…”

“…En un reciente análisis multicéntrico en el que colaboraron 9 países de Europa del Este (SIST-EAST), un tiempo P-A menor de 60 min se relacionó con ser joven o tener una puntuación en la escala NIHSS moderada-severa (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), entre otros 19 . Esto se ha explicado porque los clínicos tienden a percibir la TIV en el subgrupo de pacientes de mayor edad como menos beneficiosa.…”

“…Tiempos de actuación en min (mediana [rango intercuartílico]): tiempo inicio-puerta 84 (60-120); tiempo puerta-TC 17 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)75) tiempo TC-aguja 34 ; tiempo puerta-aguja 52 (43-70); tiempo inicio-aguja 145 (120-180). El tiempo P-A fue significativamente menor con la activación del CIE: 51 vs. 72 (p = 0,008), y mayor con la realización de angio-TC: 59 vs. 48,5 (p = 0,004) y con tiempo inicio-puerta < 90 min: 58 vs. 48 (p = 0,003).…”

Penumbra and re-canalization acute computed tomography in ischemic stroke evaluation: PRACTISE study protocol

“…Some experienced centres using routine multimodal CT report feasibility and safety, with no major delays in door to needle times. (15,52) This, however, might reflect improved efficiency in other aspects of the stroke pathway compensating for a typical 10-15 minutes of extra scanning (52,57,77,78).. Additional imaging may, however, delay treatment initiation and evidence that CTA or CTP features modify treatment effect is so far lacking (55)(56)(57), and clinicians may find the interpretation of multimodal imaging difficult (58). It is possible that multimodal imaging should be utilised in specific subgroups (55,58,79), but these are not currently possible to specify.…”