Neurological

Direct to Angiography Suite improves functional outcomes in LVO strokes shortly after the onset of symptoms

Direct transfer to angiography suite (DTAS) compared to direct transfer to computed tomography (DTCT) is safe and leads to improved clinical outcomes in patients with acute ischemic stroke caused by large vessel occlusion (LVO) that occurs within Is hospitalized 6 hours after the onset of symptoms. according to study results published in JAMA Neurology.

Endovascular treatment is the standard of care in patients with acute ischemic stroke due to LVO. The time between onset of symptoms and reperfusion is critical to clinical outcomes in patients with LVO stroke. Hence, strategies to shorten hospital workflows are important to improve functional independence outcomes.

Researchers conducted a prospective, randomized clinical trial (ANGIOCAT; ClinicalTrials.gov Identifier: NCT04001738) to determine whether patients with clinical suspicion of LVO at hospital admission (National Institutes of Health [NIH] Line scale [NIHSS] Score> 10) show better long-term clinical results after a DTAS workflow compared to patients with a conventional neuroimaging workflow in the hospital.

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The modified Rankin scale (mRS) score after 90 days for patients with confirmed LVO (modified intention-to-treat [mITT] Population) was the primary study result. Secondary efficacy results included time from hospital admission to arterial puncture, rate of dramatic early recovery, rate of mRS score of 2 or less at 90 days, and rate of endovascular treatment of patients with LVO. Safety outcomes included rates of neurological deterioration and complications, and 90-day mortality.

A total of 174 patients (mean age 73.4 ± 12.6 years; 44.8% women) were included in the study (safety analysis population: 89 [51.1%] in the DTAS group; 85 [48.9%] in the DTCT group). In the cohort, 147 patients (84.5%) presented with LVO (mITT population: 74 [50.3%] in the DTAS group; mean age 71.8 ± 13.1 years; 51.4% men; 73 [49.7%] in the DTCT group; Mean age 75.6 ± 12.3 years; 56.2% women).

The participants had a mean onset-to-door time of 228.0 ± 117.9 minutes and a median NIHSS score of 18 (interquartile range [IQR], 14-21) when recording.

The primary endpoint analysis showed an adjusted common odds ratio (OR) of a 1-point improvement in the mRS score of 2.2 (95% CI 1.2-4.1) in favor of the participants who received DTAS (P = 0.009 ). In the mITT cohort, the rate of endovascular treatment in the DTAS group was significantly higher than in the DTCT group (74 [100%] against 64 [87.7%], respectively; P = .002).

In terms of in-hospital treatment delays, patients receiving DTAS compared to DTCT had a significantly shorter median time from admission to arterial puncture (18 minutes). [IQR, 15-24 minutes] vs 42 minutes [IQR, 35-51 minutes], respectively; P <.001) as well as a shorter median time from door to reperfusion (57 minutes [IQR, 43-77 minutes] vs 84 minutes [IQR, 63-117 minutes], respectively; P <.001).

No significant differences were found between the DTAS and DTCT groups in terms of rates of clinical deterioration (10.1% and 17.6%; P = 0.15) and rates of symptomatic hemorrhagic transformation (1.2% and 17.6%, respectively) 3.8%; P = 0.40) observed) or rates of severe procedural complications (8.1% and 2.7%, respectively; P = 0.60).

The study had several limitations. The ANGIOCAT study was carried out in a single center that normally ran DTAS protocols and external data monitoring was carried out only by the Data Safety Monitoring Board. In addition, due to the premature discontinuation of the study, it was not possible to identify differences between the groups in terms of safety variables and an interim analysis may have overestimated the actual treatment effect.

“The DTAS protocol reduced hospital delays and achieved shorter times from hospital admission to onset of treatment and reperfusion, which was associated with a significant shift towards better outcomes across the spectrum of disability,” the researchers concluded.

Disclosure: Some of the study authors stated links with pharmaceutical companies. For a full list of the author’s disclosures, see the original reference.

reference

Requena M., Olivé-Gadea M., Muchada M., et al. Skip to the Continuous Angiography Suite for Computed Tomography Imaging for Patients with Acute Stroke: A Randomized Clinical Trial. JAMA Neurol. Published online August 2, 2021. doi: 10.1001 / jamaneurol.2021.2385

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