title: Time management in acute vertebrobasilar occlusion.
abstract: Acute vertebrobasilar occlusion (VBO) is associated with a high risk of stroke and death. Although local thrombolysis may achieve recanalization and improve outcome, mortality is still between 35% and 75%. However, without recanalization the chance of a good outcome is extremely poor, with mortality rates of 80-90%. Early treatment is a fundamental factor, but detailed studies of the exact time management of the diagnostic and interventional workflow are still lacking. Data on 18 patients were retrospectively evaluated. Time periods between symptom onset, admission to hospital, time of diagnosis, and beginning of intervention were correlated with postinterventional neurological status. The Glasgow Coma Scale and National Institute of Health Stroke Scale (NIHSS) were used to examine patients before and after local thrombolysis. Additionally, multivariate statistics were applied to reveal similarities between patients with neurological improvement. Primary recanalization was achieved in 77% of patients. The overall mortality was 55%. Major complications were intracranial hemorrhage and peripheral embolism. The time period from symptom onset to intervention showed a strong correlation with the postinterventional NIHSS as well as the patient's age, with the best results in a 4-h interval. Multivariate statistics revealed similarities among the patients. Evaluation of time management in acute VBO by multivariate statistics is a helpful tool for definition of similarities in this patient group. Similarly to the door-to-balloon time for acute coronary interventions, the chances for a good outcome depend on a short time interval between symptom onset and intervention. While the only manipulable time period starts with hospital admission, our results emphasize the necessity of efficient intrahospital workflow.
authors.affiliation: Department of Diagnostic and Interventional Radiology, HELIOS Klinikum Wuppertal, University Hospital Witten/Herdecke, Wuppertal, Germany. lars.kamper@helios-kliniken.de
authors.forename: Lars
authors.initials: L
authors.lastname: Kamper
authors.forename: Konrad
authors.initials: K
authors.lastname: Rybacki
authors.forename: Michael
authors.initials: M
authors.lastname: Mansour
authors.forename: Sven B
authors.initials: SB
authors.lastname: Winkler
authors.forename: Udo
authors.initials: U
authors.lastname: Kempkes
authors.forename: Patrick
authors.initials: P
authors.lastname: Haage
mesh_terms: D000208:Acute Disease; D000368:Aged; D015901:Angiography, Digital Subtraction; D003287:Contrast Media; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D012189:Retrospective Studies; D012306:Risk; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014715:Vertebrobasilar Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol