Disentangling Workflow Paradigms and Treatment Decision-Making in Acute Ischemic Stroke —Reply

In Reply We thank Ospel and Goyal for their interest in the Evaluation of Direct Transfer to Angiography Suite vs Computed Tomography Suite in Endovascular Treatment (ANGIOCAT) study and read with interest their letter in which they express some concerns in relation to the direct-to-angiography suite (DTAS) paradigm. In the ANGIOCAT study, patients adjudicated to the conventional imaging group, despite receiving computed tomography perfusion (CTP) in some cases, achieved one of the shortest workflow times reported ever (door-to-puncture time of 44 minutes). According to guidelines, CTP was never used to exclude patients from endovascular treatment (EVT) but rather to help and increase the detection of large- to medium-vessel occlusions. Our group is well aware of the so-called ghost infarct core phenomenon that makes unreliable infarct core prediction in the early time window; therefore, exclusion for EVT was solely based on the Alberta Stroke Program Early CT Score (ASPECTS) noncontrast computed tomography (CT) as recommended by the guidelines. The rate of patients presenting with an ASPECTS value of less than 5 points within the ANGIOCAT time frame (<6 hours from symptom onset) is below 10% but still possible. In these patients, the treating physician could individualize the decision to indicate EVT according to their clinical judgment and the guidelines.
Source: JAMA Neurology - Category: Neurology Source Type: research