One-Stop Management of Acute Stroke Patients

Study Questions:

Does “one-stop” imaging and thrombectomy for acute stroke patients with large-vessel occlusion help reduce door-to-groin puncture times?

Methods:

This is a retrospective, single-center, observational study of patients with suspected acute ischemic stroke who were treated via a new “one-stop” protocol compared to patients with suspected acute ischemic stroke who were treated per usual care. The “one-stop” protocol entailed direct transportation to the angiography suite for flat detector head computed tomography (CT) and CT angiography with thrombectomy if indicated. Usual care entailed conventional CT imaging followed by transportation to the angiography suite for thrombectomy if indicated. The outcome measure of interest was hospital registration-to-groin puncture (door-to-groin) time. The average door-to-groin time was compared between patients treated per the “one-stop” protocol and patients treated per usual care. Inclusion criteria were National Institutes of Health Stroke Scale (NIHSS) score of ≥10 and arrival within 5 hours of symptom onset. The exclusion criterion was arrival of the patient while the angiography suite was already occupied.

Results:

Thirty “one-stop patients” and 44 usual care patients met inclusion criteria. No hemorrhage and a large-vessel occlusion were observed in 18 of 30 (60%), which led to treatment with intravenous (IV) tissue plasminogen activator (tPA) in 11 of 18 cases and mechanical thrombectomy in all cases. Median door-to-groin time was 20.5 minutes (95% confidence interval [CI], 17-26) for the patients who were treated via the “one-stop” protocol, and 54.5 minutes (95% CI, 47-61) for patients treated per usual care. The supplemental materials reported significantly shorter median door-to-CT times, and a trend toward shorter median door-to-IV tPA times, for the “one-stop” patients. There was no increased risk of symptomatic intracerebral hemorrhage or mortality in the “one-stop” group compared to the usual care group.

Conclusions:

In this small retrospective study, “one-stop” imaging and thrombectomy for acute stroke patients with large-vessel occlusion more than halved door-to-groin times. Although numbers were low, symptomatic intracerebral hemorrhage and mortality were not higher in the “one-stop” group compared to the usual care group.

Perspective:

These results may encourage other centers to pursue “one-stop” management for acute ischemic stroke patients within 5 hours of symptom onset with NIHSS score of ≥10 in order to reduce door-to-groin times. Larger prospective studies with both efficacy and safety outcomes will bolster this study’s results. The potential costs of the “one-stop” protocol in terms of wasted resources (e.g., patients without large-vessel occlusion occupying the angiography suite) were not addressed in this article.


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