Immediate Angiography Linked to Improved Stroke Recovery

A new study suggests that direct transfer to angio-suite (DTAS), rather than a standard computed tomography (CT) scan, reduces stroke treatment time and improves recovery.

Researchers at Vall d'Hebron Hospital (Barcelona, Spain) conducted a study involving 150 stroke patients (average age 73 years), who were admitted to the hospital within six hours of stroke symptom onset with a suspected blocked blood vessel, and were randomly assigned to receive DTAS angiography (based on a flat panel non-contrast CT) or to a cardiac CT angiography and/or an CT perfusion scan to assess the indication of endovascular treatment. The primary efficacy outcome assessed was shift on the six-point modified Rankin scale (mRS) at three months.

The results showed that the stroke patients assigned to DTAS underwent testing within 19 minutes of entering the hospital, less than half of the 43 minutes for the patients who received a CT scan. Similarly, patients assigned to DTAS received endovascular treatment to restore perfusion 54 minutes faster, on average, than the CT scan recipients. At 90 days follow-up, DTAS patients were likelier than CT scan patients to show a one point improvement on the mRS. The study was presented at the International Stroke Conference, held virtually during March 2021.

“Among patients with large vessel occlusion admitted within six hours after symptom onset, direct transfer to angiography suite reduced onset to reperfusion time and improved the post-stroke disability at 90 days,” said lead author and study presenter Neurologist Manuel Requena, PhD. “Our findings were close to what we expected, and we were surprised that they occurred so early in the study. More frequent and more rapid treatment can help improve outcomes for our stroke patients.”

Timely restoration of cerebral blood flow using reperfusion therapy is the most effective maneuver for salvaging ischemic brain tissue that is not already infarcted. For eligible patients with acute ischemic stroke, intravenous alteplase is first-line therapy, provided that treatment is initiated within 4.5 hours of clearly defined symptom onset. Mechanical thrombectomy is indicated for patients with acute ischemic stroke due to a large artery occlusion in the anterior circulation who can be treated within 24 hours of the time last known to be well, regardless of whether they receive intravenous alteplase for the same ischemic stroke event.

Related Links:
Vall d'Hebron Hospital