The Comparison of Outcome between Thromboaspiration and Aggressive Mechanical Clot Disruption in Treating Hyperacute Stroke Patients

This chapter, found in the headache section of the book, provides a succinct synopsis of a key study examining the use of quantitative computed tomography (CT) scores in predicting outcomes of hyperacute stroke. This summary outlines the study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. The study showed that the ASPECTS CT score may provide an objective, simple method for helping predict which acute stroke patients are unlikely to recover despite immediate thrombolytic therapy. In addition to outlining the most salient features of the study, a clinical vignette and imaging example are included in order to provide relevant clinical context.

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Comparing different analysis methods for quantifying the MRI amide proton transfer (APT) effect in hyperacute stroke patients

NMR in Biomedicine ◽

10.1002/nbm.3147 ◽

2014 ◽

Vol 27 (9) ◽

pp. 1019-1029 ◽

Cited By ~ 52

Author(s):

Y. K. Tee ◽

G. W. J. Harston ◽

N. Blockley ◽

Thomas W. Okell ◽

J. Levman ◽

...

Keyword(s):

Proton Transfer ◽

Amide Proton ◽

Stroke Patients ◽

Hyperacute Stroke ◽

Amide Proton Transfer ◽

Analysis Methods

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Magnetic resonance cerebral metabolic rate of oxygen utilization in hyperacute stroke patients

Annals of Neurology ◽

10.1002/ana.10433 ◽

2003 ◽

Vol 53 (2) ◽

pp. 227-232 ◽

Cited By ~ 69

Author(s):

Jin-Moo Lee ◽

Katie D. Vo ◽

Hongyu An ◽

Azim Celik ◽

Yueh Lee ◽

...

Keyword(s):

Magnetic Resonance ◽

Metabolic Rate ◽

Oxygen Utilization ◽

Stroke Patients ◽

Hyperacute Stroke ◽

Cerebral Metabolic Rate

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Hyperacute stroke patients and catheter thrombolysis therapy: correlation between computed tomography perfusion maps and final infarction

Radiation Medicine ◽

10.1007/s11604-007-0219-2 ◽

2008 ◽

Vol 26 (4) ◽

pp. 227-236 ◽

Cited By ~ 1

Author(s):

Yukari Naito ◽

Shigeko Tanaka ◽

Yuichi Inoue ◽

Shinsuke Ota ◽

Saburo Sakaki ◽

...

Keyword(s):

Computed Tomography ◽

Stroke Patients ◽

Computed Tomography Perfusion ◽

Hyperacute Stroke ◽

Perfusion Maps ◽

Catheter Thrombolysis ◽

Thrombolysis Therapy

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P027: Development of a physician assistant lead stroke protocol to provide timely and equitable access to hyperacute stroke care in a telestroke community hospital

CJEM ◽

10.1017/cem.2020.234 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S74-S74

Author(s):

L. Shoots ◽

V. Bailey

Keyword(s):

Acute Stroke ◽

Local Community ◽

Community Hospital ◽

Stroke Care ◽

Physician Assistants ◽

Stroke Patients ◽

Acute Stroke Care ◽

Hyperacute Stroke ◽

Phone Calls ◽

Triage Time

Background: The Brant Community Healthcare System (BCHS) has consistently been well above the recommended 30 minute benchmark for door-to-needle (DTN) for eligible acute stroke patients. As a large community hospital with no neurologists, and like many other hospitals internationally, we rely on telestroke support for every stroke case. This is a time-consuming process that requires a multitude of phone calls, and pulls physicians from other acutely ill patients. We sought to develop a system that would streamline our approach and care for hyperacute stroke patients by targeting improvements in DTN. Aim Statement: We will decrease the door-to-needle (DTN) time for stroke patients arriving at the BCHS Emergency Department (ED) who are eligible for tissue plasminogen activator (tPA) by 25% from a median of 87 minutes to 50 minutes by March 31, 2018 and maintain that standard. Measures & Design: Outcome Measures: Door-to-needle time for acute stroke patients receiving tPA Process Measures: Door-to-triage time, Door-to-CT time, Door-to-CTA time; INR collection-to-verification time, telestroke callback time Balancing Measures: Number of stroke protocol patients per month Model Design: We simultaneously designed and implemented a robust program to train physician assistants in hyperacute stroke care. Evaluation/Results: Through vast stakeholder engagement and implementing a multitude of change ideas, by March of 2018 we had achieved an average DTN of 53 minutes. Our door-to-triage time went from an average of 7 minutes to 3 minutes. Our door-to-CT time decreased from 17 minutes to 7 minutes and our time between CT and CTA from an average of 13 minutes to 3 minutes. One and a half years later, our average DTN is maintained at 55 minutes and physician assistants continue to effectively lead and liaise with telestroke neurologists and stroke patients. Discussion/Impact: Prior to this program, acute stroke care was a very contentious topic at our local community hospital. Creating a program that streamlined the care and standardized the work has proven successful, and not only allowed for improved DTN times but also freed up physicians to better simultaneously care for other acutely ill patients.

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Impact and sustainability of centralising acute stroke services in English metropolitan areas: retrospective analysis of hospital episode statistics and stroke national audit data

BMJ ◽

10.1136/bmj.l1 ◽

2019 ◽

pp. l1 ◽

Cited By ~ 33

Author(s):

Stephen Morris ◽

Angus I G Ramsay ◽

Ruth J Boaden ◽

Rachael M Hunter ◽

Christopher McKevitt ◽

...

Keyword(s):

Hospital Stay ◽

Acute Stroke ◽

Stroke Unit ◽

Acute Hospital ◽

Evidence Based ◽

Stroke Patients ◽

Acute Stroke Care ◽

Clinical Interventions ◽

Hyperacute Stroke ◽

Stroke Services

Abstract Objectives To investigate whether further centralisation of acute stroke services in Greater Manchester in 2015 was associated with changes in outcomes and whether the effects of centralisation of acute stroke services in London in 2010 were sustained. Design Retrospective analyses of patient level data from the Hospital Episode Statistics (HES) database linked to mortality data from the Office for National Statistics, and the Sentinel Stroke National Audit Programme (SSNAP). Setting Acute stroke services in Greater Manchester and London, England. Participants 509 182 stroke patients in HES living in urban areas admitted between January 2008 and March 2016; 218 120 stroke patients in SSNAP between April 2013 and March 2016. Interventions Hub and spoke models for acute stroke care. Main outcome measures Mortality at 90 days after hospital admission; length of acute hospital stay; treatment in a hyperacute stroke unit; 19 evidence based clinical interventions. Results In Greater Manchester, borderline evidence suggested that risk adjusted mortality at 90 days declined overall; a significant decline in mortality was seen among patients treated at a hyperacute stroke unit (difference-in-differences −1.8% (95% confidence interval −3.4 to −0.2)), indicating 69 fewer deaths per year. A significant decline was seen in risk adjusted length of acute hospital stay overall (−1.5 (−2.5 to −0.4) days; P<0.01), indicating 6750 fewer bed days a year. The number of patients treated in a hyperacute stroke unit increased from 39% in 2010-12 to 86% in 2015/16. In London, the 90 day mortality rate was sustained (P>0.05), length of hospital stay declined (P<0.01), and more than 90% of patients were treated in a hyperacute stroke unit. Achievement of evidence based clinical interventions generally remained constant or improved in both areas. Conclusions Centralised models of acute stroke care, in which all stroke patients receive hyperacute care, can reduce mortality and length of acute hospital stay and improve provision of evidence based clinical interventions. Effects can be sustained over time.

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