Differences in door-to-device times in a retrospective cohort of patients with ischemic stroke who received CTA only or CTA and CTP imaging.

Publication Title

J Stroke Cerebrovasc Dis

Authors

Jason W Tarpley, Providence Little Company of Mary Medical Center, Torrance, CA, USA; Providence Saint John's Health Center, Santa Monica, CA, USA; Pacific Neuroscience Institute, Santa Monica, CA, USAFollow
Horia Marginean, Providence Brain and Spine Institute, Providence Saint Vincent Medical Center, Portland, OR, USAFollow
Weston Anderson, Providence Brain and Spine Institute, Providence Saint Vincent Medical Center, Portland, OR, USAFollow
Kamila Szweda, Providence Saint John's Health Center, Santa Monica, CA, USAFollow
Reza Bavarsad Shahripour, Providence Saint John's Health Center, Santa Monica, CA, USA
Tamela Stuchiner, Providence Brain and Spine Institute, Providence Saint Vincent Medical Center, Portland, OR, USAFollow

Document Type

Article

Publication Date

5-1-2025

Keywords

california; torrence, plcmmc; santa monica; psvmc; oregon; psjhc

Abstract

Background: In the treatment of acute ischemic stroke, there are differing views about the utility of computerized tomography perfusion (CTP). Two approaches are employed depending on hospital preference. The first approach is to perform non-contrast computed tomography (CT) scans followed by vascular imaging with computed tomography angiography (CTA) for patients arriving within 6 h of last known well. In the first approach, CTP is reserved for patients who arrive 6-24 h after last known well. The second approach is to utilize both CTA and CTP regardless of the time window in which the patient presents. In this study, we sought to answer whether patients triaged with CTP and CTA had increased door-to-device times compared to those only triaged with CTA.

Methods: We investigated a retrospective cohort of 1,357 patients with ischemic stroke who received endovascular therapy (EVT) and were triaged with CTA only or CTA and CTP. Patients were stratified by when they arrived at the hospital (< 6 h and 6-24 h from last known well). Linear mixed-effects models (LMM) were used to investigate the association between door-to-device times and CTA/CTP usage.

Results: Our results showed that using CTP and CTA was not associated with increased time to treat compared to CTA alone. There was no increase in time from door to device in patients presenting within 6 h. Furthermore, for patients who arrived 6-24 h of last known well, the use of CTP and CTA was associated with an accelerated time to treatment with EVT.

Conclusions: CTA and CTP usage was not associated with added time costs with respect to door-to-device in this patient cohort. Our results are consistent with other data showing that radiologists have faster read times when given both CTP and CTA. It is noteworthy that the majority of EVT patients in our dataset (70.6 %) presented in the < 6-hour time window.

Area of Special Interest

Neurosciences (Brain & Spine)

Specialty/Research Institute

Neurosciences

Specialty/Research Institute

Diagnostic Imaging

DOI

10.1016/j.jstrokecerebrovasdis.2025.108272