Initial medical protocol efforts using both CT and MRI/MRA for acute cerebral infarction

ElsevierVolume 61, November 2022, Pages 199-204The American Journal of Emergency MedicineAbstractBackground

Earlier administration of intravenous recombinant tissue-type plasminogen activator (rtPA) and mechanical thrombectomy (MT) improves the neurological prognosis of patients with acute ischemic stroke (AIS). We introduced a new protocol that includes head and chest computed tomography (CT) and magnetic resonance imaging (MRI)/ magnetic resonance angiography (MRA) for all patients, which is quite different from previously evaluated protocols. This study aimed to examine whether this protocol could contribute to the prompt therapeutic intervention of AIS.

Methods

This is a retrospective observational study analyzing patients with AIS who were transported to our hospital by ambulance between January 2015 and November 2021. An AIS initial treatment protocol was introduced in April 2020, under which, CT and MRI/MRA imaging were performed in all patients, and the indication for rtPA and MT were determined. The participants were divided into those who were treated before and after the protocol introduction (conventional treatment and protocol groups, respectively). The time from hospital arrival to the start of rtPA administration (door-to-needle time: DNT) and the time from hospital arrival to the start of endovascular treatment (door-to-puncture time: DPT) were compared between the groups.

Result

A total of 121 patients were analyzed, wherein 63 patients received rtPA (18 in the conventional treatment group and 45 in the protocol group) and 98 patients received MT (32 in the conventional treatment group and 66 in the protocol group). The median DNT was 97.0 (IQR 49.0–138.0) min vs. 56.5 (IQR 41.0–72.0) min (p < 0.001) for the conventional treatment and the protocol groups, respectively. The median DPT was 129.0 (IQR 62.0–196.0) min vs. 55.0 (IQR 40.5–69.5) min (p < 0.001), respectively. Moreover, DNT was achieved within 60 min in 5.6% vs. 69.9% (p < 0.001) and DPT within 90 min in 25.0% vs. 85.7% (p < 0.001), respectively.

Conclusion

The introduction of a protocol, including CT/MRI imaging, significantly shortened DNT and DPT.

Keywords

Acute ischemic stroke

Intravenous recombinant tissue-type plasminogen activator(rtPA)

Mechanical thrombectomy (MT)

Process improvement

Time

AbbreviationAHA

American Heart Association

AIS

acute ischemic stroke (AIS)

ASA

American Stroke Association

ASPECTS

Alberta Stroke Program Early Computed Tomography Score

CSC

Comprehensive Stroke Center

DWI

diffusion-weighted images

DWI-FLAIR

diffusion-weighted image and fluid-attenuated inversion recovery

MRA

magnetic resonance angiography

MRI

magnetic resonance imaging

MT

mechanical thrombectomy

NIHSS

National Institutes of Health Stroke Scale

PT-INR

prothrombin time-international normalized ratio

rtPA

recombinant tissue-type plasminogen activator

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