급성 뇌경색 환자의 혈전용해제(tPA) 투여를 위한 BEST Protocol의 유용성

The Efficacy of BEST Protocol for Injecting tPA in Acute Ischemic Stroke Patients

Purpose Stroke is the third leading cause of death in the industrialized world and the primary contributor of disability claims. Because 70% of all stroke victims are over 65, Medicare spends more on post-acute care for these patients than for acute in-patient hospital care. As the elderly population continues to grow, the situation will only worsen. This research could change BEST(brain salvage through emergent stroke therapy) protocol on how stroke patients are triaged and potentially extend treatment opportunity for those who are receiving intravenous recombinant tissue plasminogen activator- tPA(trombolytic drug) within three-to-six hour window of stroke onset. CT Perfusion imaging may dramatically improve the speed and accuracy of stroke diagnosis, enabling physicians to avoid potentially threatening complications from tPA use. In cases where our hospital used CT brain perfusion the average time between the emergency room neurological exam and CT scan time was 30minutes. At our hospital we were able to save valuable time by performing BEST protocol simultaneously with CT brain perfusion. Materials and methods For the study at Wonju Christian hospital, we conducted a retrospective analysis of 154 patients suspected of acute ischemic stroke who underwent CT brain perfusion as part of BEST protocol. 56 of these patients received tPA injections. This study was conducted with patients who presented at WCH from March, 2008 to February 2009. We used BEST protocol, performed with Philips 64 channel Brilliance CT equipment. Results We compared the time taken before and after the use of BEST protocol. The time advantage by performing BEST protocol between the emergency room neurological exam and CT scan was 24 minutes. Conclusion The study finding may have significant effect on visiting acute ischemic stroke patients. Through BEST protocol using pop up window, CT scan time was reduced by 50%. This process will dramatically improve hospital diagnostic time, most of all by reducing CT scan time, thereby helping the emergency room save precious time in stroke diagnosis, target treatment, and reduce the risks of inappropriate tPA use.