Background Mobile Stroke Units (MSU) substantially reduce time to intravenous thrombolytics and endovascular thrombectomy (EVT). MSU computed tomography (CT)-scanners perform intracranial-only CT-angiography. Whether delaying EVT to perform arch-vertex CT-angiography on hospital arrival impacts EVT procedural metrics is unknown. We hypothesised that omitting cervical CT-angiography would be associated with improved time metrics without increasing procedural time or reducing first-pass reperfusion.
Methods This multicentre retrospective analysis of the Melbourne MSU database included baseline demographics, time metrics, and procedural metrics, including the number of passes, for EVT-eligible patients at three comprehensive stroke centres in Victoria, Australia. Patients with or without acquisition of arch-vertex CT-angiography imaging prior to EVT were compared using Wilcoxon Rank-Sum.
Results Of 104 patients, 69 were re-scanned, and 35 bypassed the in-hospital CT to EVT. Baseline demographics, Glasgow Coma Scale and vascular territory, were well matched. Baseline National Institutes of Health Stroke Scale was higher in the no-repeat CT group (median 21 vs 18, p=0.001). Median time from hospital presentation to arterial puncture (30 vs 49min, p<0.001), guide-catheter placement (42.5 vs 67.5min, p<0.001), and reperfusion (71 vs 89min, p=0.003) were faster in the no-repeat CT group. Median times from puncture to guide-catheter (13.5 vs 15min, p=0.50) and reperfusion (41 vs 39min, p=0.35) were similar between groups. First-pass reperfusion (55.4% vs 62% p=0.48) and median 90-day mRS (1 vs 3, p=0.199) was similar between groups.
Conclusion Omitting repeat CT was associated with reduced times to arterial puncture and reperfusion, but not increased procedure time or reduced first pass effect.