BACKGROUND AND PURPOSE: Patients with acute ischemic stroke require immediate medical treatment, and a CT to rule out hemorrhage is required before tPA. We adapted our protocol to include multimodal CT: unenhanced CT, CTA, and PCT. The purpose of this study was to determine whether multimodal CT imaging delays initiation of IV tPA beyond 60 minutes from hospital arrival. MATERIALS AND METHODS: All patients admitted during 3 years through the ED with a stroke alert and time from symptom onset to hospital arrival <2.5 hours were included. We examined 2 subgroups (multimodal CT versus unenhanced CT) to determine whether multimodal CT delayed tPA administration. Logistic regression was used to identify variables that predicted tPA within 60 minutes. RESULTS: There were 123 patients in the analysis, including 108 patients who were examined with multimodal CT. The median time from arrival to tPA was 56 minutes and was shorter for patients examined with multimodal CT (55 versus 78 minutes, P = .02). After adjustment, variables that were associated with tPA administration within 60 minutes included prehospital stroke alert (OR = 3.47, P = .03), time to CT (OR = 0.94, P = .01), and onset-to-arrival time (OR = 1.02, P = .04). There was no statistically significant difference in the odds of receiving timely tPA for multimodal versus unenhanced CT (OR = 3.99, P = .07). CONCLUSIONS: In our single-center experience, the use of multimodal imaging in patients with acute stroke did not delay IV tPA beyond 60 minutes. Further study is needed to assess the feasibility of the routine use of multimodal imaging in the acute stroke setting.
BACKGROUND AND PURPOSE:Patients with acute ischemic stroke require immediate medical treatment, and a CT to rule out hemorrhage is required before tPA. We adapted our protocol to include multimodal CT: unenhanced CT, CTA, and PCT. The purpose of this study was to determine whether multimodal CT imaging delays initiation of IV tPA beyond 60 minutes from hospital arrival. MATERIALS AND METHODS: All patients admitted during 3 years through the ED with a stroke alert and time from symptom onset to hospital arrival <2.5 hours were included. We examined 2 subgroups (multimodal CT versus unenhanced CT) to determine whether multimodal CT delayed tPA administration. Logistic regression was used to identify variables that predicted tPA within 60 minutes. RESULTS: There were 123 patients in the analysis, including 108 patients who were examined with multimodal CT. The median time from arrival to tPA was 56 minutes and was shorter for patients examined with multimodal CT (55 versus 78 minutes, P = .02). After adjustment, variables that were associated with tPA administration within 60 minutes included prehospital stroke alert (OR = 3.47, P = .03), time to CT (OR = 0.94, P = .01), and onset-to-arrival time (OR = 1.02, P = .04). There was no statistically significant difference in the odds of receiving timely tPA for multimodal versus unenhanced CT (OR = 3.99, P = .07). CONCLUSIONS: In our single-center experience, the use of multimodal imaging in patients with acute stroke did not delay IV tPA beyond 60 minutes. Further study is needed to assess the feasibility of the routine use of multimodal imaging in the acute stroke setting.
Authors: Julio A Chalela; Chelsea S Kidwell; Lauren M Nentwich; Marie Luby; John A Butman; Andrew M Demchuk; Michael D Hill; Nicholas Patronas; Lawrence Latour; Steven Warach Journal: Lancet Date: 2007-01-27 Impact factor: 79.321
Authors: Abdul R Abdullah; Eric E Smith; Paul D Biddinger; Deidre Kalenderian; Lee H Schwamm Journal: Prehosp Emerg Care Date: 2008 Oct-Dec Impact factor: 3.077
Authors: Stephan P Kloska; Darius G Nabavi; Christiane Gaus; Eun-Mi Nam; Ernst Klotz; E Bernd Ringelstein; Walter Heindel Journal: Radiology Date: 2004-08-31 Impact factor: 11.105
Authors: Jose G Romano; Nils Muller; Jose G Merino; Alejandro M Forteza; Sebastian Koch; Alejandro A Rabinstein Journal: Neurol Res Date: 2007-10 Impact factor: 2.448
Authors: Manu Mehdiratta; Gottfried Schlaug; Sandeep Kumar; Louis R Caplan; Magdy Selim Journal: J Stroke Cerebrovasc Dis Date: 2008-09 Impact factor: 2.136
Authors: Clinton D Morgan; Marcus Stephens; Scott L Zuckerman; Magarya S Waitara; Peter J Morone; Michael C Dewan; J Mocco Journal: Interv Neuroradiol Date: 2015-06-10 Impact factor: 1.610
Authors: A Vagal; L D Foster; B Menon; A Livorine; J Shi; E Qazi; S D Yeatts; A M Demchuk; M D Hill; T A Tomsick; M Goyal Journal: AJNR Am J Neuroradiol Date: 2016-03-17 Impact factor: 3.825
Authors: Shahmir Kamalian; Shervin Kamalian; Stuart R Pomerantz; Teerath P Tanpitukpongse; Rajiv Gupta; Javier M Romero; Douglas S Katz Journal: Emerg Radiol Date: 2013-03-22
Authors: Nancy K Glober; Karl A Sporer; Kama Z Guluma; John P Serra; Joe A Barger; John F Brown; Gregory H Gilbert; Kristi L Koenig; Eric M Rudnick; Angelo A Salvucci Journal: West J Emerg Med Date: 2016-03-02