STANDARDIZED TIME FRAMES IN MANAGEMENT OF ACUTE ISCHEMIC STROKE PATIENTS

Background: Outcome studies in acute ischemic stroke have focused on time from onset of stroke symptoms to reperfusion. Definitions of other relevant key points such as "door", "imaging", "groin" and "reperfusion" were party different or missing completely. Th...

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Bibliographic Details
Published in:Clinical neuroradiology (Munich) 2019-09, Vol.29 (S1), p.S77
Main Authors: Styczen, Hanna, Sahlmann, Imke, Maus, Volker, Zapf, Antonia, Schmitz, Leonie, Liman, Jan, Psychogios, Marios-Nikos
Format: Article
Language:English
Subjects:
Care and treatment
Doors
Ischemia
Medical research
Medicine, Experimental
Prognosis
Stroke (Disease)
Stroke patients
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Summary:Background: Outcome studies in acute ischemic stroke have focused on time from onset of stroke symptoms to reperfusion. Definitions of other relevant key points such as "door", "imaging", "groin" and "reperfusion" were party different or missing completely. The aim of this study was to analyze and define standard time frames in management of acute stroke patients and investigate whether they affect outcome or predict treatment response. Methods: Five interval times from patients treated by mechanical thrombectomy were analyzed: door to imaging, imaging to groin, door to groin, groin to reperfusion and door to reperfusion. Various types of definitions for "door", "groin" and "reperfusion" were elaborated derived from international trials and publications [1-3], divided into three different timing paradigms and compared using ANOVA. Association between patient characteristics and time intervals, outcome and successful reperfusion (mTICI [greater than or equal to] 2b) were modeled by using negative binominal regression. Result: One of the described paradigms had significantly lower median groin to reperfusion time compared to the other groups (17 min vs. 40 and 44.5 min, respectively; p < 0.001). Outcome was predicted differently by the individual groups. Age, mRS and NIHSS at admission, anesthesia, intravenous thrombolysis and groin to reperfusion time had a relevant impact on mRS at discharge. Discussion: Time intervals between the three groups were significantly different with a 18 min difference between A and B (image to groin), 31 min between B and C (image to reperfusion) and 27.5 min between C and A (groin to reperfusion). Outcome was predicted differently by using the various groups. Conclusion: Standard definitions of "groin" and especially "reperfusion" are needed to ensure comparability between future studies.
ISSN:1869-1439
1869-1447