title: Vascular imaging before intravenous thrombolysis: consequences of in-hospital delay in applying two diagnostic procedures.
abstract: BACKGROUND
  Vascular imaging is increasingly used for diagnosis of arterial occlusions in acute ischemic stroke (AIS) patients. Our aim was to determine whether computed tomography angiography (CTA) and Doppler/duplex ultrasound (DUS) before intravenous thrombolysis (IVT) is associated with a delay in time-to-treatment.
  
  
  METHODS
  Observational analysis of a prospective cohort of AIS patients treated with IVT from January 2009 to December 2012. Patients were classified into three groups: the noncontrast computed tomography (NCCT) group (patients studied only with NCCT before IVT), CTA group (patients who underwent CTA in addition to NCCT), and the DUS group (patients studied with NCCT+DUS).
  
  
  RESULTS
  We treated 244 patients: 116 patients (47.5%) were studied with NCCT, 79 (32.4%) with CTA, and 49 (20.1%) with DUS. Door-to-needle time was significantly higher in the CTA group (median 60 [48-77] minutes) than in the NCCT group (51.5 [40-65]) and DUS group (48 [42-61]) (P = .008). No differences were observed for onset-to-door time and onset-to-needle time. In the multivariate linear regression analysis, onset-to-door time, prehospital stroke code activation, and performance of CTA influenced door-to-needle time.
  
  
  CONCLUSIONS
  Performing CTA before IVT seems to increase door-to-needle time. Vascular imaging based on DUS should be considered only if this does not lead to in-hospital delay.
authors: Stroke Unit, Neurology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Andrés
authors: A
authors: García Pastor
authors: Fernando
authors: F
authors: Díaz Otero
authors: Silvia
authors: S
authors: Gil Navarro
authors: Juan
authors: J
authors: Pablo Cuello
authors: Pilar
authors: P
authors: Sobrino García
authors: Amaia
authors: A
authors: García Arratibel
authors: Ana María
authors: AM
authors: Iglesias Mohedano
authors: Pilar
authors: P
authors: Vázquez Alen
authors: Yolanda
authors: Y
authors: Fernandez Bullido
authors: Jose Antonio
authors: JA
authors: Villanueva Osorio
authors: Antonio
authors: A
authors: Gil Nuñez
mesh_terms: D000368:Aged; D002533:Cerebral Angiography / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004453:Echoencephalography / Q000706:statistics & numerical data*; D005260:Female; D005343:Fibrinolytic Agents; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D015912:Thrombolytic Therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex / Q000706:statistics & numerical data; D014850:Waiting Lists
chemical_list: D005343:Fibrinolytic Agents
keywords: Acute ischemic stroke; CT-angiography; door-to-needle time; neurosonology; vascular imaging