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Original research
High-resolution CT with arch/neck/head CT angiography on a mobile stroke unit
  1. Anne W Alexandrov1,
  2. Adam S Arthur2,3,
  3. Tomas Bryndziar1,
  4. Victoria M Swatzell1,
  5. Wendy Dusenbury1,
  6. Keri Hardage1,
  7. Sarah McCormick1,
  8. James P Rhudy1,
  9. Ana Hossein Zadeh Maleki1,
  10. Savdeep Singh1,
  11. Balaji Krishnaiah1,
  12. Katherine Nearing1,
  13. Mark N Rubin1,
  14. Marc D Malkoff1,
  15. Christopher McKendry1,
  16. E Jeffrey Metter1,
  17. Andrei V Alexandrov1
  1. 1Neurology, UTHSC COM, Memphis, Tennessee, USA
  2. 2Neurosurgery, UTHSC COM, Memphis, Tennessee, USA
  3. 3Vascular Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
  1. Correspondence to Professor Anne W Alexandrov, Neurology, UTHSC COM, Memphis, Tennessee, USA; anne{at}outcomesmgmt.org

Abstract

Background Mobile stroke units (MSUs) performance dependability and diagnostic yield of 16-slice, ultra-fast CT with auto-injection angiography (CTA) of the aortic arch/neck/circle of Willis has not been previously reported.

Methods We performed a prospective observational study of the first-of-its kind MSU equipped with high resolution, 16-slice CT with multiphasic CTA. Field CT/CTA was performed on all suspected stroke patients regardless of symptom severity or resolution. Performance dependability, efficiency and diagnostic yield over 365 days was quantified.

Results 1031 MSU emergency activations occurred; of these, 629 (61%) were disregarded with unrelated diagnoses, and 402 patients transported: 245 (61%) ischemic or hemorrhagic stroke, 17 (4%) transient ischemic attack, 140 (35%) other neurologic emergencies. Total time from non-contrast CT/CTA start to images ready for viewing was 4.0 (IQR 3.5–4.5) min. Hemorrhagic stroke totaled 24 (10%): aneurysmal subarachnoid hemorrhage 3, hemorrhagic infarct 1, and 20 intraparenchymal hemorrhages (median intracerebral hemorrhage score was 2 (IQR 1–3), 4 (20%) spot sign positive). In 221 patients with ischemic stroke, 73 (33%) received alteplase with 31.5% treated within 60 min of onset. CTA revealed large vessel occlusion in 66 patients (30%) of which 9 (14%) were extracranial; 27 (41%) underwent thrombectomy with onset to puncture time averaging 141±90 min (median 112 (IQR 90–139) min) with full emergency department (ED) bypass. No imaging needed to be repeated for image quality; all patients were triaged correctly with no inter-hospital transfer required.

Conclusions MSU use of advanced imaging including multiphasic head/neck CTA is feasible, offers high LVO yield and enables full ED bypass.

  • CT angiography
  • CT
  • stroke
  • thrombectomy
  • thrombolysis

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. The registry supporting this study consists of de-identified participant data from the UTHSC Mobile Stroke Unit. The data are not available for reuse.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. The registry supporting this study consists of de-identified participant data from the UTHSC Mobile Stroke Unit. The data are not available for reuse.

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Footnotes

  • Contributors AA, ASA, EJM, MDM, and AVA designed the study supporting this work. TB, VMS, WD, JPR, AHZM, and SS along with CM collected all the individual patient data in this work. SM and KH collected and archived all imaging data. Imaging data were interpreted formally and entered into the database by MDM, BK, MNR and KN. AWA, EJM and AVA analyzed/interpreted the data presented in this work. The manuscript was drafted and revised by AWA, ASA, EJM, MDM, and AVA. All authors reviewed and approved the final version of the manuscript and agree to be accountable for all aspects of the work.

  • Funding This work was supported by the Assisi Foundation (Memphis, TN), grant #18-060.

  • Competing interests Tomas Bryndziar reports employment at Bristol-Myers Squibb outside the submitted work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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