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Routine CT Angiography in Acute Stroke Does Not Delay Thrombolytic Therapy

Published online by Cambridge University Press:  02 December 2014

Simerpreet Bal ,
Bijoy K. Menon ,
Andrew M. Demchuk ,
Michael D. Hill  and
for the Calgary CTA Study Group
Simerpreet Bal
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
Bijoy K. Menon
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
Andrew M. Demchuk
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
Michael D. Hill*
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
*
Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss, Brain Institute, University of Calgary, Foothills Hospital, Rm 1242A, 1403 29th Street NW, Calgary, Alberta, T2N 2T9, Canada. Email: michael.hill@ucalgary.ca
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Abstract

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Introduction:

Lack of additional utility over non-contract computed tomography (NCCT) in decision making and delay in door to needle time are arguments used against routine computed tomographic angiography (CTA) use in acute ischemic stroke management. We compare interval times during a CTA based acute ischemic stroke protocol with an earlier non-CTA based protocol at our center.

Methods:

We reviewed 850 stroke thrombolysis patients in a university hospital in Canada from April 1996 to December 2009. Time to treatment was divided into the following interval times: onset-to-door, door-to-needle and onset-to-needle. Patients were categorized into: Group 1 (April 1996-Dec 2002) (Non-contrast CT Scan based thrombolysis) n=297, Group 2 (Jan 2004-Dec 2009) (CTA based thrombolysis) n=504. The period from Jan to Dec 2003 (n=49) was considered a washout period as we had started the CTA protocol that year. Interval times were compared between the two groups.

Results:

Interval times in Group 1 and Group 2 were: median onset-to-door times in Group 1 [55 minutes (IQR 48),] and Group 2 [61 minutes (IQR 57)] (p=0.019); median door-to-needle times in Group 1 [67 minutes(IQR 43)] and Group 2 [62.5 minutes (IQR 52)] (p=0.519); median onset-to-needle times in Group 1 (139 minutes (IQR 73)] and Group 2 (141.5 min (IQR 109.5) (p=0.468). In multivariable linear regression analysis, age and onset-to-door time influenced the door-to-needle time. For every decade of age, door-to-needle times were 5.4 minutes faster.

Conclusions:

CTA based thrombolytic approach for acute ischemic stroke does not significantly delay thrombolysis in routine clinical practice.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 39 , Issue 4 , July 2012 , pp. 499 - 501
Copyright
Copyright © The Canadian Journal of Neurological 2012

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