title: Influence of a combined CT/C-arm system on periprocedural workflow and procedure times in mechanical thrombectomy.
abstract: OBJECTIVE
  To achieve the fastest possible workflow in ischaemic stroke, we developed a CT/C-arm system, which allows imaging and endovascular treatment on the same patient table.
  
  
  METHODS
  This prospective, monocentric trial was conducted between October 2014 and August 2016. Patients received stroke imaging and mechanical thrombectomy under general anaesthesia (GA) or conscious sedation (CS) using our combined setup comprising a CT-scanner and a mobile C-arm X-ray device. Primary endpoint was time between stroke imaging and groin puncture. We compared periprocedural workflow and procedure times with the literature and a matched patient cohort treated with a biplane angiographic system before installation of the CT/C-arm system.
  
  
  RESULTS
  In 50 patients with acute ischaemic stroke due to large-vessel occlusion in the anterior circulation, comparable recanalization rates were achieved by using the CT/C-arm setup (TICI2b-3:CT/C-arm-GA: 85.7%; CT/C-arm-CS: 90.9%; Angiosuite: 78.6%; p = 0.269) without increasing periprocedural complications. Elimination of patient transport resulted in a significant reduction of the time between stroke imaging and groin puncture: median, min (IQR): CT/C-arm-GA: 43 (35-52); CT/C-arm-CS: 39 (28-49); Angiosuite: 64 (48-74); p < 0.0001.
  
  
  CONCLUSIONS
  The combined CT/C-arm system allows comparable recanalization rates as a biplane angiographic system and accelerates the start of the endovascular stroke treatment.
  
  
  CONCLUSIONS
  • The CT/C-arm setup reduces median time from stroke imaging to groin puncture. • Mechanical thrombectomy using a C-arm device is feasible without increasing peri-interventional complications. • The CT/C-arm setup might be a valuable fallback solution for emergency procedures. • The CT/C-arm setup allows immediate control CT images during and after treatment.
authors.affiliation: Department of Neuroradiology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Pfaff
authors.affiliation: Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
authors.forename: Silvia
authors.initials: S
authors.lastname: Schönenberger
authors.affiliation: Department of Neuroradiology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Herweh
authors.affiliation: Department of Neuroradiology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
authors.forename: Mirko
authors.initials: M
authors.lastname: Pham
authors.affiliation: Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Nagel
authors.affiliation: Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
authors.forename: Peter Arthur
authors.initials: PA
authors.lastname: Ringleb
authors.affiliation: Department of Neuroradiology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Heiland
authors.affiliation: Department of Neuroradiology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Bendszus
authors.affiliation: Department of Neuroradiology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. markus.moehlenbruch@med.uni-heidelberg.de.
authors.forename: Markus Alfred
authors.initials: MA
authors.lastname: Möhlenbruch
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000379:methods; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000379:methods*; D061646:Operative Time; D011446:Prospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000628:therapy*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D057188:Workflow; D014965:X-Rays
keywords: Acute ischaemic stroke; Combined CT/C-arm system; Mechanical thrombectomy; Periprocedural workflow; Procedure times