ABSTRACT
INTRODUCTION: Too few patients benefit from endovascular therapy (EVT) in large vessel occlusion acute stroke (LVOS), and various acute stroke care paradigms are currently investigated to reduce these inequalities in health access. We aimed to investigate whether newly set-up thrombectomy-capable stroke centers (TSC) offered a safe, effective and cost-effective procedure. PATIENTS AND METHODS: This French retrospective study compared the outcomes of LVOS patients with an indication for EVT and treated at the Perpignan hospital before on-site thrombectomy was available (Primary stroke center), and after formation of local radiology team for neurointervention (TSC). Primary endpoints were 3-months functional outcomes, assessed by the modified Rankin scale. Various safety endpoints for ischemic and hemorragic procedural complications were assessed. We conducted a medico-economic analysis to estimate the cost-benefit of becoming a TSC for the hospital. RESULTS: The differences between 422 patients in the PSC and 266 in the TSC were adjusted by the means of weighted logistic regression. Patients treated in the TSC had higher odds of excellent functional outcome (aOR 1.77 [1.16-2.72], p = 0.008), with no significant differences in the rates of procedural complications. The TSC setting shortened onset-to-reperfusion times by 144 min (95% CI [131-155]; p < 0.0001), and was cost-effective after 21 treated LVOS patients. On-site thrombectomy saves 10.825 per patient for the hospital. DISCUSSION: Our results demonstrate that the TSC setting improves functional outcomes and reduces intra-hospital costs in LVOS patients. TSCs could play a major public health role in acute stroke care and access to EVT.
ABSTRACT
PURPOSE: The use of coronary computed tomography angiography (CCTA) in children remains limited by patient's irradiation, and motion artefacts impairing image quality. Triggering the acquisition at the appropriate moment, and acquiring only necessary components of the cardiac cycle could overcome these limitations. Yet, optimal cardiac intervals to perform CCTA as a function of heart rate (HR) have not yet been addressed in pediatrics. METHODS: Fifty children with coronary artery anomalies underwent a CCTA on a wide-coverage single-beat CT scanner. Multiple phases from 25% to 85% of the R-R interval were acquired and reconstructed with 10% increments. Two radiologists independently assessed motion artifacts on each cardiac phase using a 4-point semi-quantitative scale. RESULTS: At patient level, the best phase for acquisition was found in diastole for patients with HR ≤ 75 bpm and in systole for patients with HR > 85 bpm. At coronary segments and structures level, median optimal phases were reported at 70%, 80%, 47%, 50%, and 54% of the R-R interval for patients with HR ≤ 60, 61-75, 86-100, 101-130, and >130 bpm respectively. For patients with HR between 76 and 85 bpm, no clear trend could be observed. Optimal acquisition durations represented 10% (2 phases), 20% (3 phases), 50% (multiphase), 20% (3 phases), and 10% (2 phases) of the R-R interval for patients with HR ≤ 60, 61-75, 76-100, 101-130, and >130 bpm, respectively. CONCLUSIONS: Optimal positioning and duration of CCTA acquisition intervals were investigated as a function of children's HR, to reduce motion artifacts and patient's irradiation.
