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J Neurointerv Surg. 2017 Apr;9(4):340-345. doi: 10.1136/neurintsurg-2016-012324. Epub 2016 Apr 5.

Streamlining door to recanalization processes in endovascular stroke therapy.

Author information

1
Department of Neurology, UPMC Stroke Institute, Pittsburgh, Pennsylvania, USA.
2
Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA.
3
Department of Neurology, Emory University, Atlanta, Georgia, USA.
4
Winchester Neurological Consultants, Winchester, Virginia, USA.
5
Soroka Medical Center, Beersheba, Israel.
6
Department of Emergency Medicine, UPMC Stroke Institute, Pittsburgh, Pennsylvania, USA.
7
Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

Abstract

BACKGROUND:

In acute stroke due to large vessel occlusion, faster reperfusion leads to better outcomes. We analyzed the effect of optimization steps aimed to reduce treatment delays at our center.

METHODS:

Consecutive patients with ischemic stroke treated with endovascular therapy were prospectively analyzed. We divided the patients into pre-optimization (20 April 2012 to 8 October 2013) and post-optimization (9 October 2013 to 29 July 2014) periods. The main interventions included: (1) continuous feedback; (2) standardized immediate emergency department attending to stroke attending communication with interventional team activation for all potential interventions; (3) pre-notification by the emergency medical service; (4) minimizing additional diagnostic testing; (5) direct transport to the CT scanner; (6) transport directly from the CT scanner to the angiography suite. The main metric used to measure improvement was door to groin puncture time (D2P).

RESULTS:

We included a total of 286 patients (178 pre-optimization, 108 post-optimization). There were no significant differences between major baseline characteristics between the groups with the exception of higher median CT Alberta Stroke Program Early CT Score in the pre-optimization group (p=0.01). Median D2P improved from 105 min pre-optimization to 67 min post-optimization (p=0.0002). Rates of good clinical outcomes (modified Rankin Scale 0-2 at 3 months) were similar in both groups, with a trend toward a better outcome in the post-optimization group in a subgroup analysis of patients with anterior circulation occlusion who received intravenous tissue plasminogen activator.

CONCLUSIONS:

This pilot study demonstrates that D2P times can be significantly reduced with a standardized multidisciplinary approach. There was no significant difference in the rate of 3-month good outcome, which is most likely due to the small sample size and confounding baseline patient characteristics.

KEYWORDS:

Intervention; Stroke; Thrombectomy

PMID:
27048957
DOI:
10.1136/neurintsurg-2016-012324
[Indexed for MEDLINE]

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