Understanding Delays in MRI-based Selection of Large Vessel Occlusion Stroke Patients for Endovascular Thrombectomy.

Autor: Regenhardt RW; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, USA, 02114. robert.regenhardt@mgh.harvard.edu.; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA, 02114. robert.regenhardt@mgh.harvard.edu., Nolan NM; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA, 02114., Rosenthal JA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA, 02114., McIntyre JA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA, 02114., Bretzner M; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA, 02114., Bonkhoff AK; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA, 02114., Snider SB; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA, 02114., Das AS; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA, 02114., Alotaibi NM; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, USA, 02114., Vranic JE; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, USA, 02114.; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA, 02114., Dmytriw AA; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, USA, 02114.; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA, 02114., Stapleton CJ; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, USA, 02114., Patel AB; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, USA, 02114., Rost NS; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA, 02114., Leslie-Mazwi TM; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, USA, 02114.; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA, 02114.
Jazyk: angličtina
Zdroj: Clinical neuroradiology [Clin Neuroradiol] 2022 Dec; Vol. 32 (4), pp. 979-986. Date of Electronic Publication: 2022 Apr 29.
DOI: 10.1007/s00062-022-01165-y
Abstrakt: Purpose: Given the efficacy of endovascular thrombectomy (EVT), optimizing systems of delivery is crucial. Magnetic resonance imaging (MRI) is the gold standard for evaluating tissue viability but may require more time to obtain and interpret. We sought to identify determinants of arrival-to-puncture time for patients who underwent MRI-based EVT selection in a real-world setting.
Methods: Patients were identified from a prospectively maintained database from 2011-2019 that included demographics, presentations, treatments, and outcomes. Process times were obtained from the medical charts. MRI times were obtained from time stamps on the first sequence. Linear and logistic regressions were used to infer explanatory variables of arrival-to-puncture times and effects of arrival-to-puncture time on functional outcomes.
Results: In this study 192 patients (median age 70 years, 57% women, 12% non-white) underwent MRI-based EVT selection. 66% also underwent computed tomography (CT) at the hub before EVT. General anesthesia was used for 33%. Among the entire cohort, the median arrival-to-puncture was 102 min; however, among those without CT it was 77 min. Longer arrival-to-puncture times independently reduced the odds of 90-day good outcome (∆mRS ≤ 2 from pre-stroke, aOR = 0.990, 95%CI = 0.981-0.999, p = 0.040) when controlling for age, NIHSS, and good reperfusion (TICI 2b-3). Independent determinants of longer arrival-to-puncture were CT plus MRI (β = 0.205, p = 0.003), non-white race/ethnicity (β = 0.162, p = 0.012), coronary disease (β = 0.205, p = 0.001), and general anesthesia (β = 0.364, p < 0.0001).
Conclusion: Minimizing arrival-to-puncture time is important for outcomes. Real-world challenges exist in an MRI-based EVT selection protocol; avoiding double imaging is key to saving time. Racial/ethnic disparities require further study. Understanding variables associated with delay will inform protocol changes.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
Databáze: MEDLINE
Externí odkaz: