Pre- and in-hospital delays from stroke onset to intra-arterial thrombolysis.
OBJECTIVE
Thrombolysis for treatment of acute ischemic stroke should be administered as fast as possible after symptom onset. The aim of this study was to examine, in our tertiary care center, the time intervals preceding intra-arterial thrombolysis in order to accelerate and optimize the management of acute strokes.


METHODS
Between January 1, 2000, and April 30, 2002, 597 patients with acute stroke were admitted to our stroke center. One hundred forty-eight patients underwent diagnostic arteriography, and 100 (16.8%) received intra-arterial thrombolysis. For all patients, we prospectively recorded and analyzed the time of symptom onset, admission, CT and/or MRI scan, diagnostic arteriography, and, if performed, intra-arterial thrombolysis.


RESULTS
The mean time to arrival in the emergency department was 99 minutes for patients who were admitted directly (Bern patients), 127 minutes for those who were referred from community hospitals without a CT scanner (non-Bern/-CT patients), and 210 minutes for patients from hospitals with imaging facilities (non-Bern/+CT patients). The mean delay from symptom onset to treatment was 234 minutes for Bern patients, 269 minutes for non-Bern/-CT patients, and 302 minutes for non-Bern/+CT patients. The patients from the last group needed longer to receive intra-arterial thrombolysis than did patients who were admitted directly (P=0.002) or who were transferred from a hospital without a CT scanner (P=0.03).


CONCLUSIONS
This prospective study indicates that direct referral without prior imaging at community hospitals shortens the time until intra-arterial thrombolysis. In addition, our in-hospital delay preceding intra-arterial thrombolysis is longer than the delays reported for intravenous thrombolysis and indicates potential for improvement.
Nedeltchev
Krassen
K
Department of Neurology, University Hospital of Bern, Bern, Switzerland.
Arnold
Marcel
M
Brekenfeld
Caspar
C
Isenegger
Jörg
J
Remonda
Luca
L
Schroth
Gerhard
G
Mattle
Heinrich P
HP
D000368:Aged; D019090:Case Management; D002391:Catchment Area, Health; D002533:Cerebral Angiography; D004630:Emergencies / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007269:Injections, Intra-Arterial; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012017:Referral and Consultation; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology; D013557:Switzerland / Q000453:epidemiology; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014187:Transportation of Patients / Q000706:statistics & numerical data; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator