Flat-panel detector CT assessment in stroke to reduce times to intra-arterial treatment: A study of multiphase computed tomography angiography in the angiography suite to bypass conventional imaging

Abstract

Background Bypassing the emergency department and the computed tomography suite by directly transporting to the neuroangiography suite for imaging assessment and treatment may shorten reperfusion times while maintaining proper patient selection. Objective To determine whether flat-panel detector multiphase computed tomography angiography protocol is associated with reduced treatment times and a similar safety profile as the standard imaging protocol. Methods Single-center prospective study of consecutive patients with anterior circulation large vessel occlusion strokes transferred to our facility for consideration of endovascular therapy from May 2016 to December 2017. Those with basilar strokes and/or presenting to the emergency department were excluded. Patients were categorized into two groups: (1) flat-panel detector CT assessment in stroke to reduce times to intra-arterial treatment group, with patients transferred directly to the suite for multiphase computed tomography angiography; and (2) patients undergoing standard protocol including computed tomography ± computed tomography angiography/CT perfusion. The groups were matched for age, baseline National Institute of Health Stroke Scale, and pretreatment glucose. Baseline characteristics, time metrics, and outcomes were compared. Results Out of 419 patients who underwent endovascular therapy over the study period, 210 patients fit inclusion criteria, with 54 (25.7%) in the flat-panel detector CT assessment in stroke to reduce times to intra-arterial treatment group. After matching, 49 flat-panel detector CT assessment in stroke to reduce times to intra-arterial treatment/control pairs were generated and analyzed. Baseline characteristics were well balanced. Flat-panel detector CT assessment in stroke to reduce times to intra-arterial treatment patients had significantly shorter median door-to-puncture (33 [26.5-47] vs. 55 [44.5–66] min, p < 0.001), door-to-reperfusion (85 [57.5–115.5] vs. 110 [80–153], p = 0.005) and picture-to-puncture (18 [13.5–22.5] vs. 42 [32–47.5] min, p < 0.001) times. There were no differences in rates of successful reperfusion (modified thrombolysis in cerebral infarction 2b-3, 95.9% vs. 100%, p = 0.5), parenchymal hematomas type-2 (4.1% vs. 2%, p = 1.00), good outcome (90-day modified Rankin Scale 0–2, 44.9% vs. 40.8%, p = 0.68), and 90-day mortality (14.3% vs. 22.4%, p = 0.30). Conclusion Directly transferring patients to angiography and using multiphase computed tomography angiography to determine the eligibility for endovascular therapy is safe and may result in a significant reduction in treatment times. Future larger studies are warranted.