פוסט זה זמין גם ב:
עברית
Anthony S. Kim, MD, reviewing
Direct transfer to the angiography suite without stopping for computed tomography improved functional outcomes in a single-center randomized trial, although many patients already had conventional CT done at a primary stroke center before transfer.
The benefits of endovascular stroke treatment for large vessel occlusion (LVO) stroke are time sensitive, so clinicians have sought to further refine in-hospital workflows to improve patient outcomes. The model of direct transfer to the angiography suite (DTAS) without stopping in the emergency department is already well established for ST-elevation myocardial infarction, but this approach has been less well studied for LVO stroke, which typically requires CT imaging.
Researchers now report the results of a single-center randomized trial comparing DTAS to a conventional workflow in patients with suspected LVO stroke (based on a prehospital Rapid Arterial Occlusion Evaluation score >4) who presented within 6 hours of symptom onset and had moderately severe stroke and favorable premorbid functional status. After excluding those presenting off-hours, those without EMS prenotification, and those presenting when the angiography suite was unavailable, 174 patients were randomized, and LVO was confirmed in 147. DTAS patients had the option of a flat-panel CT in the angiography suite to rule out intracranial hemorrhage or large established infarct and to diagnose an LVO before catheter angiography if needed, but approximately two thirds of these patients had been evaluated initially at a primary stroke center, and many had a CT scan before transfer.
Median door-to-puncture and door-to-reperfusion times with DTAS were 18 minutes and 57 minutes, respectively, versus 42 minutes and 84 minutes with a conventional workflow. The DTAS group was more likely to receive endovascular stroke treatment and had better functional outcome at 90 days.
COMMENT
These results are promising, but more clarity would be welcome on the relative contributions of a higher treatment rate versus a faster treatment time to the observed differences; on whether a flat-panel CT in the angiography suite rather than a conventional CT scan in the emergency department truly suffices; on the reasons why the effect of DTAS on outcomes is modified by direct admission versus transfer; and on the generalizability of these results to other centers.
למאמר המלא לחץ כאן