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Impact of Transcranial Doppler Ultrasound on Logistics and Outcomes in Stroke Thrombolysis: Results From the SITS-ISTR

MV. Mazya, N. Ahmed, E. Azevedo, A. Davalos, L. Dorado, M. Karlinski, S. Lorenzano, J. Neumann, D. Toni, TP. Moreira, SITS Investigators,

. 2018 ; 49 (7) : 1695-1700. [pub] 20180529

Language English Country United States

Document type Journal Article, Research Support, Non-U.S. Gov't

Persistent link   https://www.medvik.cz/link/bmc19035210

BACKGROUND AND PURPOSE: Diagnostic transcranial Doppler ultrasound (TCD) is commonly used in patients with acute stroke before or during treatment with intravenous thrombolysis (IVT). We aimed to assess how much TCD delays IVT initiation and whether TCD influences outcomes. METHODS: We analyzed data from the SITS-ISTR (Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register) collected from December 2002 to December 2011. Outcomes were door-to-needle time, symptomatic intracerebral hemorrhage, functional outcome per the modified Rankin Scale, and mortality at 3 months. RESULTS: In hospitals performing any TCD pre-IVT, 1701 of 11 265 patients (15%) had TCD before IVT initiation. Door-to-needle time was higher in patients with pre-IVT TCD (74 versus 60 minutes; P<0.001). At hospitals performing any TCD during IVT infusion, of 9044 patients with IVT, 747 were examined with TCD during IVT. No treatment delay was seen with TCD during IVT. After multivariate adjustment, TCD during IVT was independently associated with modestly increased excellent functional outcome (modified Rankin Scale, 0-1; adjusted odds ratio, 1.28; 95% confidence interval, 1.06-1.55; P=0.012) and lower mortality (adjusted odds ratio, 0.73; 95% confidence interval, 0.55-0.95; P=0.022). CONCLUSIONS: We recommend that TCD, if performed, should be done during IVT infusion, to avoid treatment delay. The association of hyperacute TCD with beneficial outcomes suggests potential impact on patient management, which warrants further study.

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$a Mazya, Michael V $u From the Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (M.V.M., N.A., T.P.M.) michael.mazya@karolinska.se. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (M.V.M., N.A., T.P.M.).
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$a Impact of Transcranial Doppler Ultrasound on Logistics and Outcomes in Stroke Thrombolysis: Results From the SITS-ISTR / $c MV. Mazya, N. Ahmed, E. Azevedo, A. Davalos, L. Dorado, M. Karlinski, S. Lorenzano, J. Neumann, D. Toni, TP. Moreira, SITS Investigators,
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$a BACKGROUND AND PURPOSE: Diagnostic transcranial Doppler ultrasound (TCD) is commonly used in patients with acute stroke before or during treatment with intravenous thrombolysis (IVT). We aimed to assess how much TCD delays IVT initiation and whether TCD influences outcomes. METHODS: We analyzed data from the SITS-ISTR (Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register) collected from December 2002 to December 2011. Outcomes were door-to-needle time, symptomatic intracerebral hemorrhage, functional outcome per the modified Rankin Scale, and mortality at 3 months. RESULTS: In hospitals performing any TCD pre-IVT, 1701 of 11 265 patients (15%) had TCD before IVT initiation. Door-to-needle time was higher in patients with pre-IVT TCD (74 versus 60 minutes; P<0.001). At hospitals performing any TCD during IVT infusion, of 9044 patients with IVT, 747 were examined with TCD during IVT. No treatment delay was seen with TCD during IVT. After multivariate adjustment, TCD during IVT was independently associated with modestly increased excellent functional outcome (modified Rankin Scale, 0-1; adjusted odds ratio, 1.28; 95% confidence interval, 1.06-1.55; P=0.012) and lower mortality (adjusted odds ratio, 0.73; 95% confidence interval, 0.55-0.95; P=0.022). CONCLUSIONS: We recommend that TCD, if performed, should be done during IVT infusion, to avoid treatment delay. The association of hyperacute TCD with beneficial outcomes suggests potential impact on patient management, which warrants further study.
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$a Ahmed, Niaz $u From the Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (M.V.M., N.A., T.P.M.). Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (M.V.M., N.A., T.P.M.).
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$a Azevedo, Elsa $u Department of Neurology, Hospital São João, University of Porto, Portugal (E.A.).
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$a Davalos, Antoni $u Department of Neurosciences, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain (A.D., L.D.).
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$a Dorado, Laura $u Department of Neurosciences, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain (A.D., L.D.).
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$a Karlinski, Michal $u Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (M.K.).
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$a Lorenzano, Svetlana $u Department of Neurology and Psychiatry, University of Rome-La Sapienza, Italy (S.L., D.T.).
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$a Neumann, Jiří $u Department of Neurology and Stroke Center, County Hospital Chomutov, Czech Republic (J.N.).
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$a Toni, Danilo $u Department of Neurology and Psychiatry, University of Rome-La Sapienza, Italy (S.L., D.T.).
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$a Moreira, Tiago P $u From the Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (M.V.M., N.A., T.P.M.). Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (M.V.M., N.A., T.P.M.).
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