Interventional radiologists can transfer skills used in the periphery to treat stroke with good outcomes

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David J Burkart
David J Burkart

A study, published online on 8 July in the Journal of Vascular and Interventional Radiology, found that peripheral interventional radiologists who use CT perfusion imaging for patient selection had good neurologic outcomes when they treated stroke patients. 

David J Burkart and colleagues reported that the study set out to assess the safety and efficacy of intra-arterial mechanical thrombectomy to treat ischaemic stroke in a community hospital as performed by peripheral interventional radiologists employing computed tomography (CT) perfusion imaging for patient selection.

The research team found that peripheral interventional radiologists who use CT perfusion imaging for patient triage can have good neurologic outcomes and provide sustainable, safe, and complete around-the-clock coverage for endovascular stroke treatment.

Burkart told NeuroNews and Interventional News, “The article is important because it demonstrates peripheral interventional radiologists with appropriate additional training can help provide safe and sustainable endovascular stroke therapy with outcomes that equal or exceed other published trials. Our hope is collaboration between the appropriate interventional specialties will effectively move forward the emergent care of stroke patients. This study highlights the importance of image-guided patient triage which the authors believe is important to optimise outcomes. The article includes a discussion of the most recent endovascular stroke trials including important lessons for future trials.”

The small study used data from 40 patients (11 men, 29 women) who were treated between February 2008 and October 2011. Eligible patients had a National Institutes of Health Stroke Scale (NIHSS) score greater than eight. They were diagnosed as having large-vessel ischaemic stroke by head CT angiogram, and met previously reported CT perfusion imaging triage criteria.

Results

The investigators reported that the baseline NIHSS score was 18±7.9 (range, 8–35). Sixteen patients had a baseline NIHSS score greater than 20. They also noted that symptom onset was unknown in five patients. In the remaining 35 patients, the time of onset of symptoms to the device time was 254.8 seconds ±150.9 (range, 75–775 minutes). A total of 65% of patients showed thrombolysis in cerebral infarction (TICI) 2a, 2b, or 3 flow following the procedure.

With regard to complications, researchers reported that four patients had symptomatic intracranial haemorrhage. At the three-month mark, 32 patients were alive. The modified Rankin scale (mRs) score at three months was no more than two in 20 patients. The mean mRS score at 90 days was 2.9±2 (range, 0–6). NIHSS score in the same time frame was 5.1±6.1 (range, 0–24). In patients with successful recanalisation (ie. TICI2 or 3 flow), a good clinical outcome (ie. mRS score ≤2) was achieved in 65.3% of patients, and three-month mortality rate was 15.4%, compared with 28.6% in patients with TICI 0/1 flow.

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