Background Access to endovascular therapy (ET) in cases of acute ischemic stroke may be limited, and rapid transfer of eligible patients to hospitals with endovascular capability is needed.
Objective To determine the optimal timing of diagnostic CT angiography to confirm large vessel occlusion (LVO).
Methods Of 57 emergency department transfers to Mount Sinai Hospital (MSH) for possible ET from January 2015 through March 2016, 39 (68%) underwent ET, among whom 22 (56%) had CT angiography before transfer and 17 (44%) had CT angiography on arrival. We compared mean outside hospital arrival to groin puncture (OTG) time between the two groups using t-tests and Wilcoxon rank sum tests. OTG was defined as the difference between groin puncture and outside hospital arrival time minus ambulance travel time.
Results Average age was 73±13 years and average National Institute of Health Stroke Scale score was 19±5. There was no difference in average OTG time between the two groups (191 min for CT angiography at outside hospital vs 190 min for CT angiography at MSH (p=0.99 for t-test and 0.69 for rank sum test)). Among the 18 patients who were transferred but did not receive ET, 10 had no LVO, 5 had large established infarcts on arrival and 3 had post-tissue plasminogen activator hemorrhage. In 9/10 patients without LVO, CT angiography was not performed before transfer.
Conclusions CT angiography timing in the transfer process does not affect OTG time, but 90% of patients without LVO had not had CT angiography before transfer. Hence, it might be beneficial to obtain a CT angiogram at the outside hospital, if it can be acquired and read rapidly, to avoid the cost and potential clinical deterioration associated with unnecessary transfers.
- CT Angiography
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LS and JWL contributed equally to this paper and are co-first authors, listed alphabetically.
Contributors LS monitored data collection, and drafted and revised the paper. JWL initiated the project, designed data collection tools, monitored data collection, and drafted and revised the paper. NW designed data collection tools, monitored data collection, and revised the paper. JTF and ST monitored data collection and revised the paper. MSD wrote the statistical analysis plan, cleaned and analysed the data, monitored data collection, and revised the paper. He is guarantor.
Competing interests None declared.
Ethics approval Mount Sinai Hospital institutional review board.
Provenance and peer review Not commissioned; externally peer reviewed.