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Off-hour admission and impact on neurological outcome in endovascular treatment for acute ischemic stroke

Journal article
Authors Pia Löwhagen Hendén
Alexandros Rentzos
Jan-Erik Karlsson
Lars Rosengren
Jonatan Oras
Sven-Erik Ricksten
Published in Acta Anaesthesiologica Scandinavica
Volume 36
Issue 2
Pages 208-214
ISSN 0001-5172
Publication year 2019
Published at Institute of Clinical Sciences, Department of Anesthesiology and Intensive care
Institute of Neuroscience and Physiology, Department of Clinical Neuroscience
Institute of Clinical Sciences, Department of Radiology
Pages 208-214
Language en
Links doi.org/10.1111/aas.13241
Keywords acute ischemic stroke, brain infarction, endovascular treatment
Subject categories Radiology, Nuclear Medicine and Medical Imaging, Anesthesiology and Intensive Care, Neurology

Abstract

© 2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd Background and Purpose: In the new era of endovascular treatment for acute ischemic stroke, one of the main predictors of good neurological outcome is a short time interval from stroke onset to recanalization of the occluded vessel. In this study, we examined the effect of on-hour vs off-hour admittance on the time intervals from stroke onset to recanalization in patients with acute ischemic stroke (AIS) undergoing endovascular treatment (EVT). Methods: One-hundred-ninety-eight patients receiving EVT for anterior AIS between 2007 and 2016 were included. Time of day and weekday for stroke admittance were recorded as well as several time intervals. Age, sex, co-morbidities, admission National Institutes of Health Stroke Scale (NIHSS), intraprocedural blood pressure, blood glucose, modified Thrombolysis in Cerebral Ischemia score (mTICI) and neurological outcome at 3 months, measured as modified Rankin Scale (mRS), were registered. On-hour was defined as 8 am-4 pm weekdays, and off-hour as weekdays outside these hours and weekends. Results: The time interval from CT (computed tomography) to recanalization was longer during off-hours, while no difference was seen in the time interval from stroke onset to CT. No statistically significant difference was seen in neurological outcome between the on- and off-hour groups in a univariate analysis. Conclusions: Stroke admittance during off-hours is associated with longer time interval from CT examination to vessel recanalization. The study highlights the need of logistic improvement and probably more resources off-hour in order to deliver an effective stroke care around the clock.

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