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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Initial experience with upfront arterial and perfusion imaging among ischemic stroke patients presenting within the 4.5-hour time window
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Initial experience with upfront arterial and perfusion imaging among ischemic stroke patients presenting within the 4.5-hour time window

机译：在4.5小时时间内出现的缺血性中风患者的前期动脉和灌注成像初步经验

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Background: Although perfusion imaging is being evaluated as a tool to select acute ischemic stroke patients who are most likely to benefit from reperfusion therapies beyond the standard time windows, there are limited data on the utility of perfusion imaging within the intravenous (IV) thrombolytic time window. Methods: A new stroke imaging protocol was initiated at Emory University Hospital including computed tomographic angiography (CTA) and computed tomographic perfusion (CTP). All patients presenting within 4.5 hours from last known normal time with suspected stroke were prospectively identified. Impact of CTA and CTP on the clinical management was recorded prospectively by stroke team members. Results: During the study period, 87 patients met eligibility criteria for the CTA/CTP protocol, of which 83 (95%) underwent this upfront comprehensive imaging protocol and 30 (34%) received IV thrombolytics. Overall, stroke team members reported that CTA and/or CTP aided their clinical management in 39 (47%) cases, including aiding in identification of a nonstroke diagnosis (n = 18), triage to the neurologic intensive care unit (n = 9), early triage to endovascular therapy (n = 4), and initiation of IV thrombolytic for low National Institutes of Health Stroke Scale score with large vessel occlusion (n = 3). Door to needle time ≤60 minutes was achieved in only 18% of patients receiving IV thrombolysis during the study period, but had improved to 44% in the subsequent 6-month period. Conclusions: An upfront CTA/CTP protocol aided stroke team decision-making in nearly half of cases. Implementation of a CTA/CTP protocol was associated with a learning curve of 6 months before door to needle time ≤60 minutes returned to similar rates as the pre-CTA/CTP protocol.
机译：背景：尽管正在评估灌注成像作为选择最可能在标准时间范围之外最可能从再灌注治疗中受益的急性缺血性中风患者的工具，但有关在静脉溶栓时间内的灌注成像实用性的数据有限窗口。方法：在埃默里大学医院发起了一种新的卒中影像学方案，包括计算机断层造影血管造影（CTA）和计算机断层造影灌注（CTP）。前瞻性鉴定了自上次已知正常时间起4.5小时内出现可疑中风的所有患者。脑卒中小组成员前瞻性地记录了CTA和CTP对临床管理的影响。结果：在研究期间，有87位患者符合CTA / CTP方案的入选标准，其中83例（95％）接受了这种前期全面成像方案，其中30例（34％）接受了IV溶栓治疗。总体而言，中风团队成员报告说，CTA和/或CTP在39例（47％）病例中辅助了其临床管理，包括协助识别非中风诊断（n = 18），分诊至神经科重症监护病房（n = 9）。 ，早期分流至血管内治疗（n = 4），以及因大血管闭塞（n = 3）而导致的国立卫生研究院卒中量表评分低而开始进行静脉溶栓治疗。在研究期间，仅18％接受静脉溶栓治疗的患者达到了门到针时间≤60分钟，但在随后的6个月中提高到44％。结论：在近一半的案例中，预先的CTA / CTP协议有助于中风团队的决策。 CTA / CTP协议的实施与6个月的学习曲线相关，门到针的时间≤60分钟才恢复到与CTA / CTP之前的协议相似的速率。

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