Evaluation of time-dependent pathways in an acute ischemic stroke protocol that incorporates CT perfusion

A tertiary referral center experience

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1 Citation (Scopus)

Abstract

Background and Objective: Intravenous thrombolysis service for stroke was introduced at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in 2009, based on the recommendations of a multidisciplinary team of clinicians. We report the experience at our center in establishing a stroke protocol incorporating computed tomography perfusion (CTP) of the brain, to assess the feasibility of incorporating CTP in the stroke protocol. Methods: A retrospective review of all patients who had a CTP between January 2010 and December 2011 was performed. Results: Of 272 patients who were admitted with acute ischemic stroke, 44 (16.2%) arrived within 4.5 hours from symptom onset and had a CTP performed with the intention to treat. The median time for symptom-to-door, symptom-to-scan and door-to-scan was 90.0 minutes (62.5 - 146.3), 211.0 minutes (165.5 - 273.5) and 85.0 minutes (48.0 - 144.8) respectively. Eight patients (2.9%) were thrombolysed of whom five received IV thrombolysis and three underwent mechanical thrombolysis. The median symptom-to-needle and door-to-needle times were 290.5 minutes (261.3 - 405.0) and 225.0 minutes (172.5 - 316.8) respectively. Four patients were thrombolysed despite being outside the window of treatment based on the CTP findings. Six of the thrombolysed patients had a Modified Rankin Score (MRS) of 1-2 at 5 months post procedure. Conclusions: CTP provides a benefit to management decisions and subsequent patient outcome. It is feasible to incorporate CTP as a standard imaging modality in a stroke protocol. The delays in the time-dependent pathways are due to our work flow and organisational process rather than performing the CTP per se.

Original languageEnglish
Pages (from-to)355-360
Number of pages6
JournalNeurology Asia
Volume18
Issue number4
Publication statusPublished - Dec 2013

Fingerprint

Tertiary Care Centers
Perfusion
Stroke
Tomography
Needles
Mechanical Thrombolysis
Workflow
CT protocol
Malaysia
Brain

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

@article{b782afa9befd4cde839c23742e6a909c,
title = "Evaluation of time-dependent pathways in an acute ischemic stroke protocol that incorporates CT perfusion: A tertiary referral center experience",
abstract = "Background and Objective: Intravenous thrombolysis service for stroke was introduced at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in 2009, based on the recommendations of a multidisciplinary team of clinicians. We report the experience at our center in establishing a stroke protocol incorporating computed tomography perfusion (CTP) of the brain, to assess the feasibility of incorporating CTP in the stroke protocol. Methods: A retrospective review of all patients who had a CTP between January 2010 and December 2011 was performed. Results: Of 272 patients who were admitted with acute ischemic stroke, 44 (16.2{\%}) arrived within 4.5 hours from symptom onset and had a CTP performed with the intention to treat. The median time for symptom-to-door, symptom-to-scan and door-to-scan was 90.0 minutes (62.5 - 146.3), 211.0 minutes (165.5 - 273.5) and 85.0 minutes (48.0 - 144.8) respectively. Eight patients (2.9{\%}) were thrombolysed of whom five received IV thrombolysis and three underwent mechanical thrombolysis. The median symptom-to-needle and door-to-needle times were 290.5 minutes (261.3 - 405.0) and 225.0 minutes (172.5 - 316.8) respectively. Four patients were thrombolysed despite being outside the window of treatment based on the CTP findings. Six of the thrombolysed patients had a Modified Rankin Score (MRS) of 1-2 at 5 months post procedure. Conclusions: CTP provides a benefit to management decisions and subsequent patient outcome. It is feasible to incorporate CTP as a standard imaging modality in a stroke protocol. The delays in the time-dependent pathways are due to our work flow and organisational process rather than performing the CTP per se.",
author = "Hilwati Hashim and Radhiana Hassan and Osman, {Syazarina Sharis} and {Md. Rani}, {Shahrul Azmin} and Rabani Remli and {Mohamed Mukari}, {Shahizon Azura} and {Wan Yahya}, {Wan Nur Nafisah} and Tan, {Hui Jan} and {Mohamed Ibrahim}, Norlinah and {Mohd. Saiboon}, Ismail and Sobri Muda and Ramesh Sahathevan",
year = "2013",
month = "12",
language = "English",
volume = "18",
pages = "355--360",
journal = "Neurology Asia",
issn = "1823-6138",
publisher = "ASEAN Neurological Association",
number = "4",

}

TY - JOUR

T1 - Evaluation of time-dependent pathways in an acute ischemic stroke protocol that incorporates CT perfusion

T2 - A tertiary referral center experience

AU - Hashim, Hilwati

AU - Hassan, Radhiana

AU - Osman, Syazarina Sharis

AU - Md. Rani, Shahrul Azmin

AU - Remli, Rabani

AU - Mohamed Mukari, Shahizon Azura

AU - Wan Yahya, Wan Nur Nafisah

AU - Tan, Hui Jan

AU - Mohamed Ibrahim, Norlinah

AU - Mohd. Saiboon, Ismail

AU - Muda, Sobri

AU - Sahathevan, Ramesh

PY - 2013/12

Y1 - 2013/12

N2 - Background and Objective: Intravenous thrombolysis service for stroke was introduced at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in 2009, based on the recommendations of a multidisciplinary team of clinicians. We report the experience at our center in establishing a stroke protocol incorporating computed tomography perfusion (CTP) of the brain, to assess the feasibility of incorporating CTP in the stroke protocol. Methods: A retrospective review of all patients who had a CTP between January 2010 and December 2011 was performed. Results: Of 272 patients who were admitted with acute ischemic stroke, 44 (16.2%) arrived within 4.5 hours from symptom onset and had a CTP performed with the intention to treat. The median time for symptom-to-door, symptom-to-scan and door-to-scan was 90.0 minutes (62.5 - 146.3), 211.0 minutes (165.5 - 273.5) and 85.0 minutes (48.0 - 144.8) respectively. Eight patients (2.9%) were thrombolysed of whom five received IV thrombolysis and three underwent mechanical thrombolysis. The median symptom-to-needle and door-to-needle times were 290.5 minutes (261.3 - 405.0) and 225.0 minutes (172.5 - 316.8) respectively. Four patients were thrombolysed despite being outside the window of treatment based on the CTP findings. Six of the thrombolysed patients had a Modified Rankin Score (MRS) of 1-2 at 5 months post procedure. Conclusions: CTP provides a benefit to management decisions and subsequent patient outcome. It is feasible to incorporate CTP as a standard imaging modality in a stroke protocol. The delays in the time-dependent pathways are due to our work flow and organisational process rather than performing the CTP per se.

AB - Background and Objective: Intravenous thrombolysis service for stroke was introduced at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in 2009, based on the recommendations of a multidisciplinary team of clinicians. We report the experience at our center in establishing a stroke protocol incorporating computed tomography perfusion (CTP) of the brain, to assess the feasibility of incorporating CTP in the stroke protocol. Methods: A retrospective review of all patients who had a CTP between January 2010 and December 2011 was performed. Results: Of 272 patients who were admitted with acute ischemic stroke, 44 (16.2%) arrived within 4.5 hours from symptom onset and had a CTP performed with the intention to treat. The median time for symptom-to-door, symptom-to-scan and door-to-scan was 90.0 minutes (62.5 - 146.3), 211.0 minutes (165.5 - 273.5) and 85.0 minutes (48.0 - 144.8) respectively. Eight patients (2.9%) were thrombolysed of whom five received IV thrombolysis and three underwent mechanical thrombolysis. The median symptom-to-needle and door-to-needle times were 290.5 minutes (261.3 - 405.0) and 225.0 minutes (172.5 - 316.8) respectively. Four patients were thrombolysed despite being outside the window of treatment based on the CTP findings. Six of the thrombolysed patients had a Modified Rankin Score (MRS) of 1-2 at 5 months post procedure. Conclusions: CTP provides a benefit to management decisions and subsequent patient outcome. It is feasible to incorporate CTP as a standard imaging modality in a stroke protocol. The delays in the time-dependent pathways are due to our work flow and organisational process rather than performing the CTP per se.

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M3 - Article

VL - 18

SP - 355

EP - 360

JO - Neurology Asia

JF - Neurology Asia

SN - 1823-6138

IS - 4

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