title: Beating the clock: time delays to thrombolytic therapy with advanced imaging and impact of optimized workflow.
abstract: BACKGROUND
  The effectiveness of intravenous tissue plasminogen activator in the management of acute ischemic strokes diminishes significantly with time. Advanced computed tomography (CT) imaging can be helpful to identify candidates for neurointerventional procedures. We have successfully used a 320-slice Toshiba volume CT scanner since mid-2008. Other centers have forgone advanced imaging because of concerns of time delay. This study is to assess the time delay while using this scanner compared with our 64-slice scanner.
  
  
  METHODS
  Treatment times of patients scanned with advanced imaging (CT head, dynamic CT angiography, and whole brain perfusion-group A) and patients scanned in a 64-slice scanner (CT head and traditional CT angiogram-group B) were compared. Two groups of stroke patients from November-March 2009-2010 (group 1) and 2012-2013 (group 2) were audited to assess temporal improvement. Multiple timing variables were analyzed.
  
  
  RESULTS
  One hundred fifty-three cases from 2009/10 and 192 cases from 2012/13 were analyzed. The median door-to-needle time (DNT) for group 1A and group 2A was 57 minutes and 47 minutes, respectively. The median DNT for group 1B and group 2B was 54 minutes and 49 minutes, respectively. Decrease in the overall DNT with group A can be attributed to the "streamlining" of the stroke code process. There was no difference in the DNT for patients who presented during working hours versus those who presented during nonworking hours.
  
  
  CONCLUSIONS
  With adequate experience and training, advanced stroke imaging with whole brain perfusion/dynamic CT angiography can be performed with treatment times that are comparable with traditional CT scanning.
authors.affiliation: Division of Neuroradiology, Department of Medical Imaging, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada. Electronic address: schakraborty@toh.on.ca.
authors.forename: Santanu
authors.initials: S
authors.lastname: Chakraborty
authors.affiliation: Division of Neuroradiology, Department of Medical Imaging, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Ross
authors.affiliation: Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada.
authors.forename: Mathew J
authors.initials: MJ
authors.lastname: Hogan
authors.affiliation: Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada.
authors.forename: Dar
authors.initials: D
authors.lastname: Dowlatshahi
authors.affiliation: Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada.
authors.forename: Grant
authors.initials: G
authors.lastname: Stotts
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000188:drug therapy; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D059906:Neuroimaging; D011859:Radiography; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015912:Thrombolytic Therapy; D013997:Time Factors; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D057188:Workflow
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Acute stroke; CT perfusion; door-to-needle time; imaging; time delay