RT Journal Article
SR Electronic
T1 High-resolution CT with arch/neck/head CT angiography on a mobile stroke unit
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP neurintsurg-2021-017697
DO 10.1136/neurintsurg-2021-017697
A1 Anne W Alexandrov
A1 Adam S Arthur
A1 Tomas Bryndziar
A1 Victoria M Swatzell
A1 Wendy Dusenbury
A1 Keri Hardage
A1 Sarah McCormick
A1 James P Rhudy
A1 Ana Hossein Zadeh Maleki
A1 Savdeep Singh
A1 Balaji Krishnaiah
A1 Katherine Nearing
A1 Mark N Rubin
A1 Marc D Malkoff
A1 Christopher McKendry
A1 E Jeffrey Metter
A1 Andrei V Alexandrov
YR 2021
UL http://jnis.bmj.com/content/early/2021/08/24/neurintsurg-2021-017697.abstract
AB 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.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.