TY - JOUR
T1 - Prehospital Computed Tomography Angiography in Acute Stroke Management
AU - Kettner, Michael
AU - Helwig, Stefan Alexander
AU - Ragoschke-Schumm, Andreas
AU - Schwindling, Lenka
AU - Roumia, Safwan
AU - Keller, Isabel
AU - Martens, Daniel
AU - Kulikovski, Johann
AU - Manitz, Matthias
AU - Lesmeister, Martin
AU - Walter, Silke
AU - Grunwald, Iris Quasar
AU - Schlechtriemen, Thomas
AU - Reith, Wolfgang
AU - Fassbender, Klaus
N1 - Funding Information:
This study was funded by grants from the Ministry of Health of the Saarland, Germany, the “Rettungszweckverband Saar” and the German Red Cross, Saarland, Germany.
Publisher Copyright:
© 2017 S. Karger AG, Basel.
PY - 2017/12/1
Y1 - 2017/12/1
N2 - Background: An ambulance equipped with a computed tomography (CT) scanner, a point-of-care laboratory, and telemedicine capabilities (mobile stroke unit [MSU]) has been shown to enable the delivery of thrombolysis to stroke patients directly at the emergency site, thereby significantly decreasing time to treatment. However, work-up in an MSU that includes CT angiography (CTA) may also potentially facilitate triage of patients directly to the appropriate target hospital and specialized treatment, according to their individual vascular pathology.Methods: Our institution manages a program investigating the prehospital management of patients with suspicion of acute stroke. Here, we report a range of scenarios in which prehospital CTA could be relevant in triaging patients to the appropriate target hospital and to the individually required treatment.Results: Prehospital CTA by use of an MSU allowed to detect large vessel occlusion of the middle cerebral artery in one patient with ischemic stroke and occlusion of the basilar artery in another, thereby allowing rational triage to comprehensive stroke centers for immediate intra-arterial treatment. In complementary cases, prehospital imaging not only allowed diagnosis of parenchymal hemorrhage with a spot sign indicating ongoing bleeding in one patient and of subarachnoid hemorrhage in another but also clarified the underlying vascular pathology, which was relevant for subsequent triage decisions.Conclusion: Defining the vascular pathology by CTA directly at the emergency site may be beneficial in triaging patients with various cerebrovascular diseases to the most appropriate target hospital and specialized treatment.
AB - Background: An ambulance equipped with a computed tomography (CT) scanner, a point-of-care laboratory, and telemedicine capabilities (mobile stroke unit [MSU]) has been shown to enable the delivery of thrombolysis to stroke patients directly at the emergency site, thereby significantly decreasing time to treatment. However, work-up in an MSU that includes CT angiography (CTA) may also potentially facilitate triage of patients directly to the appropriate target hospital and specialized treatment, according to their individual vascular pathology.Methods: Our institution manages a program investigating the prehospital management of patients with suspicion of acute stroke. Here, we report a range of scenarios in which prehospital CTA could be relevant in triaging patients to the appropriate target hospital and to the individually required treatment.Results: Prehospital CTA by use of an MSU allowed to detect large vessel occlusion of the middle cerebral artery in one patient with ischemic stroke and occlusion of the basilar artery in another, thereby allowing rational triage to comprehensive stroke centers for immediate intra-arterial treatment. In complementary cases, prehospital imaging not only allowed diagnosis of parenchymal hemorrhage with a spot sign indicating ongoing bleeding in one patient and of subarachnoid hemorrhage in another but also clarified the underlying vascular pathology, which was relevant for subsequent triage decisions.Conclusion: Defining the vascular pathology by CTA directly at the emergency site may be beneficial in triaging patients with various cerebrovascular diseases to the most appropriate target hospital and specialized treatment.
KW - Aneurysm
KW - Angiography
KW - Computed tomography
KW - Intra-arterial treatment
KW - Large vessel occlusion
KW - Stroke
KW - Subarachnoid
KW - Triage
UR - http://www.scopus.com/inward/record.url?scp=85033384893&partnerID=8YFLogxK
U2 - 10.1159/000484097
DO - 10.1159/000484097
M3 - Article
C2 - 29130951
AN - SCOPUS:85033384893
SN - 1015-9770
VL - 44
SP - 338
EP - 343
JO - Cerebrovascular Diseases
JF - Cerebrovascular Diseases
IS - 5-6
ER -