title: Efficacy of peripheral interventional radiologists performing endovascular stroke therapy guided by CT perfusion triage of patients.
abstract: OBJECTIVE
  To assess safety and efficacy of intraarterial mechanical thrombectomy for treatment of ischemic stroke in a community hospital by peripheral interventional radiologists employing computed tomography (CT) perfusion imaging for patient selection.
  
  
  METHODS
  Forty patients, 11 men (27.5%) and 29 women (72.5%), were treated between February 2008 and October 2011. Eligible patients had a National Institutes of Health Stroke Scale (NIHSS) score greater than 8 and diagnosis of large-vessel ischemic stroke by head CT angiogram, and met previously reported CT perfusion imaging triage criteria.
  
  
  RESULTS
  The baseline NIHSS score was 18.0 ± 7.9 (range, 8-35). Sixteen patients (40%) had a baseline NIHSS score greater than 20. Symptom onset was unknown in five patients. Symptom onset to device time in the remaining 35 patients was 254.8 minutes ± 150.9 (range, 75-775 min). A total of 65% of patients showed thrombolysis in cerebral infarction (TICI) 2a, 2b, or 3 flow following the procedure. Symptomatic intracranial hemorrhage was seen in four patients (10.0%). At 90 days, 32 patients (80%) were alive and eight (20%) had died. The modified Rankin scale (mRS) score at 90 days was no more than 2 in 20 patients (50.0%). The mean mRS score at 90 days was 2.9 ± 2.0 (range, 0-6). NIHSS score at 90 days was 5.1 ± 6.1 (range, 0-24). In patients with successful recanalization (ie, TICI 2 or 3 flow), a good clinical outcome (ie, mRS score ≤ 2) was achieved in 65.3% of patients (mean, 2.4 ± 1.9; range, 0-6), and 90-day mortality rate was 15.4%, compared with 28.6% in patients with TICI 0/1 flow.
  
  
  CONCLUSIONS
  Peripheral interventional radiologists who use CT perfusion imaging for patient triage can have good neurologic outcomes and provide sustainable, safe, and complete around-the-clock coverage for endovascular stroke treatment.
authors.affiliation: Healient Physician Group, 4801 College Blvd., Leawood, KS 66211, USA. djb13md@gmail.com
authors.forename: David J
authors.initials: DJ
authors.lastname: Burkart
authors.forename: Jason S
authors.initials: JS
authors.lastname: Day
authors.forename: Kathleen
authors.initials: K
authors.lastname: Henderson
authors.forename: John J
authors.initials: JJ
authors.lastname: Borsa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014218:Triage / Q000379:methods
keywords: ICH; IMS; Interventional Management of Stroke [trial]; NIHSS; National Institutes of Health Stroke Scale; TICI; intracranial hemorrhage; mRS; modified Rankin scale; tPA; thrombolysis in cerebral infarction; tissue plasminogen activator