Evaluation of time-dependent pathways in an acute ischemic stroke protocol that incorporates CT perfusion: A tertiary referral center experience
- Author:
Hilwati Hashim
;
Radhiana Hassan
;
Syazarina Sharis
;
Shahrul Azmin
;
Rabani Remli
;
Shahizon Azura Mukari
;
Nafisah Yahya
;
Hui Jan Tan
;
Norlinah Mohamed Ibrahim
;
Mohd Saiboon Ismail
;
Sobri Muda
;
Ramesh Sahathevan
- Publication Type:Journal Article
- From:Neurology Asia
2013;18(4):355-360
- CountryMalaysia
- Language:English
-
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.
- Full text:P020150702583597117386.pdf
