Title :

Understanding Delays in MRI-based Selection of Large Vessel Occlusion Stroke Patients for Endovascular Thrombectomy

Author(s) :

Regenhardt, R. W. [Auteur]
Harvard Medical School [Boston] [HMS]
Nolan, N. M. [Auteur]
Massachusetts General Hospital [Boston, MA, USA]
Rosenthal, J. A. [Auteur]
Massachusetts General Hospital [Boston, MA, USA]
Mcintyre, J. A. [Auteur]
Massachusetts General Hospital [Boston, MA, USA]
Bretzner, Martin [Auteur]
Massachusetts General Hospital [Boston]
Bonkhoff, A. K. [Auteur]
Snider, S. B. [Auteur]
Das, A. S. [Auteur]
Alotaibi, N. M. [Auteur]
Vranic, J. E. [Auteur]
Dmytriw, A. A. [Auteur]
Stapleton, C. J. [Auteur]
Patel, A. B. [Auteur]
Rost, N. S. [Auteur]
Massachusetts General Hospital [Boston]
Leslie-Mazwi, T. M. [Auteur]
Massachusetts General Hospital [Boston, MA, USA]

Journal title :

Clinical Neuroradiology

Abbreviated title :

Clin. Neuroradiol.

Volume number :

32

Pages :

979-986

Publisher :

Springer

Publication date :

2023-05-30

ISSN :

1869-1439

Keyword(s) :

Ischemic stroke
Systems of care
Process improvement
Magnetic resonance imaging

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Purpose Given the efficacy of endovascular thrombectomy (EVT), optimizing systems of delivery is crucial. Magnetic resonance imaging (MRI) is the gold standard for evaluating tissue viability but may require more time ...
Show more >Purpose Given the efficacy of endovascular thrombectomy (EVT), optimizing systems of delivery is crucial. Magnetic resonance imaging (MRI) is the gold standard for evaluating tissue viability but may require more time to obtain and interpret. We sought to identify determinants of arrival-to-puncture time for patients who underwent MRI-based EVT selection in a real-world setting. Methods Patients were identified from a prospectively maintained database from 2011–2019 that included demographics, presentations, treatments, and outcomes. Process times were obtained from the medical charts. MRI times were obtained from time stamps on the first sequence. Linear and logistic regressions were used to infer explanatory variables of arrival-to-puncture times and effects of arrival-to-puncture time on functional outcomes. Results In this study 192 patients (median age 70 years, 57% women, 12% non-white) underwent MRI-based EVT selection. 66% also underwent computed tomography (CT) at the hub before EVT. General anesthesia was used for 33%. Among the entire cohort, the median arrival-to-puncture was 102 min; however, among those without CT it was 77 min. Longer arrival-to-puncture times independently reduced the odds of 90-day good outcome (∆mRS ≤ 2 from pre-stroke, aOR = 0.990, 95%CI = 0.981–0.999, p = 0.040) when controlling for age, NIHSS, and good reperfusion (TICI 2b–3). Independent determinants of longer arrival-to-puncture were CT plus MRI (β = 0.205, p = 0.003), non-white race/ethnicity (β = 0.162, p = 0.012), coronary disease (β = 0.205, p = 0.001), and general anesthesia (β = 0.364, p < 0.0001). Conclusion Minimizing arrival-to-puncture time is important for outcomes. Real-world challenges exist in an MRI-based EVT selection protocol; avoiding double imaging is key to saving time. Racial/ethnic disparities require further study. Understanding variables associated with delay will inform protocol changes.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

Université de Lille
Inserm
CHU Lille

Collections :

• Lille Neurosciences & Cognition (LilNCog) - U 1172

Submission date :

2024-01-16T01:15:39Z
2024-10-09T09:27:39Z