Triage using CT perfusion imaging versus no CT perfusion imaging in patients undergoing mechanical thrombectomy

Background: Optimization of workflow and reduction of times are critical in the management of patients with acute ischemic stroke. Strong evidence of thrombectomy is superior to medical therapy alone in the management of selected cases with large vessels occlusion. The role of advanced imaging to select those patients remains uncertain. Other challenge of acute stroke therapy is inter-facility transfer, which may add significant delay to treatment. The use of CT perfusion (CTP) and CT angiography could assist in the selection of the appropriate patient for transfer and could reduce de door to puncture time when done at the referral facility.

Objective: To compare differences in time to treatment for acute ischemic stroke patients transferred to our center for possible endovascular therapy using CTP RAPID versus those transferred without CTP at spoke hospitals.

Methods: Single center retrospective review of a prospectively maintained database of consecutive ischemic stroke patients transferred to our center for consideration of endovascular therapy. Group 1 consisted of patients triaged using CTP at a spoke hospital using RAPID software, and group 2 consisted of transfer patients who did not undergo CTP imaging at the spoke hospital prior to transfer.

Results: A total of 132 transferred patients were identified from April 2014 to April 2017. There were no differences in baseline characteristics between the two groups. Among the 117 patients who underwent endovascular therapy, complete reperfusion (TICI 2B or 3) was achieved in 105 (89.7%). Group 1 had 34 patients, against 98 patients on group 2. Door-to-puncture time was significantly shorter for patients in Group 1 vs Group 2 (median [IQR], 12 [8–16] minutes vs 48.5 [32.8–71.8] minutes, p < 001). There was no difference in door in and door out time between groups (median [IQR], 96 [59.5–133] min vs 94 [65.5–164] min, p = 0.57). Rate of good clinical outcome was nominally higher in patients triaged using CTP at the spoke hospital compared with patient without CTP, although this was not statically significant (55.9% and 44.9%).

Conclusion: Triaging from a primary stroke center after CTP RAPID significantly reduce door-to-puncture time without any significant delay in transfer process, when compared with patients transferred with no perfusion imaging.

No conflict of interest has been declared by the author(s).