Introduction/Purpose Triage of stroke patient involves cross-sectional non-contrast head imaging and vascular imaging, either CT or MR angiogram, after arrival to the emergency room. While stroke pathways have been optimized and prioritize stroke patient imaging over other imaging requests in the ED, there is still precious time lost if a patient is found to require hospital-to-hospital transfer (about 50% of patients) or in-hospital transport to the angiography suite for endovascular treatment. Therefore, complete stroke patient triage in an angiography suite with capability to acquire non-contrast head CT and CT angiogram imaging on the interventional table may be the next step in optimizing triage and ultimately care for our stroke patients.
Materials and Methods In the setting of WE-TRUST (Workflow optimization to rEduce Time to endovascular ReperfUsion in Stroke Treatment) study initiation, implementation of a ‘direct to angio suite’ (DTAS) workflow using the novel Philips technology for cone-beam CT angiogram protocol to obtain vascular imaging.
Results In patients with acute ischemic stroke due to large vessel occlusion (LVO), clinical outcome is closely tied to how quickly these patients receive endovascular treatment. Optimization of stroke pathways and in-hospital workflows has come a long way in recent years, already showing a huge benefit. However, the triage step of imaging acquisition still looses precious time as a patient eligible for endovascular treatment needs to be transported to the angio suite. The aim of the WE-TRUST study is to provide the most comprehensive DTAS workflow to date by incorporating the technology for imaging triage into the angiography machine. CT image acquisition is fast, reliable and of excellent diagnostic quality. In addition to further optimizing stroke pathways, capability to perform CT/CTA acquisition in the angiography suite may be a useful tool in patients showing marked improvement after IV thrombolysis administration. With Tenecteplase being considered more potent than tissue plasminogen activator and gaining acceptance for use in acute ischemic stroke treatment due to ease of administration and advantageous drug characteristics, evaluation of clot location or even its resolution can be performed in the angiography suite. The need for groin/wrist puncture and intravascular catheter manipulation is eliminated if imaging determines a too distal location of the clot or its resolution. Determination of clot location can also help guide tool selection based on location in a vascular territory and size of the occluded vessel.
Conclusion DTAS triage workflow with cone-beam head CT and CTA image acquisition in the angiography suite may be a next step to further optimize LVO stroke pathways by bypassing conventional CT/MR. This new workflow has the potential to further decrease door-to-needle times and thereby may improve patient outcome.
Disclosures A. Kuhn: None. J. Singh: None. M. Garcia: None. S. Sarid: None. M. Gounis: 1; C; National Institutes of Health (NIH), the United States – Israel Binational Science Foundation, Anaconda, ApicBio, Arsenal Medical, Axovant, Balt, Cerenovus, Ceretrieve, CereVasc LLC, Cook Medical, Gal. 2; C; fee-per-hour basis for Alembic LLC, Astrocyte Pharmaceuticals, BendIt Technologies, Cerenovus, Imperative Care, Jacob’s Institute, Medtronic Neurovascular, Mivi Neurosciences, phenox GMbH, Q’Apel, Rou. 4; C; Imperative Care, InNeuroCo, Galaxy Therapeutics and Neurogami. V. Anagnostakou: None. A. Puri: 1; C; NIH, Microvention, Cerenovus, Medtronic Neurovascular and Stryker Neurovascular. 2; C; Medtronic Neurovascular, Stryker NeurovascularBalt, Q’Apel Medical, Cerenovus, Microvention, Imperative Care, Agile, Merit, CereVasc and Arsenal Medical. 4; C; InNeuroCo, Agile, Perfuze, Galaxy and NTI.
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