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J Neurointerv Surg. 2018 May;10(5):424-428. doi: 10.1136/neurintsurg-2017-013198. Epub 2017 Aug 30.

Workflow and factors associated with delay in the delivery of intra-arterial treatment for acute ischemic stroke in the MR CLEAN trial.

Author information

1
Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
2
Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands.
3
Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
4
Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands.
5
Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
6
Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
7
Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.
8
Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands.
#
Contributed equally

Abstract

OBJECTIVE:

The effect of intra-arterial treatment (IAT) for acute ischemic stroke is highly time-dependent. We investigated the delay of IAT and factors associated with such delay.

METHODS:

MR CLEAN was a randomized trial of IAT plus usual care versus usual care alone (n=500). With multivariable linear regression, we analyzed the effect of intravenous treatment, general anesthesia, off-hours and inter-hospital transfer on time to admission to the emergency department (ED) of the intervention center and time to treatment. Furthermore, we assessed compliance with a target of 75 min for time from ED to treatment, and calculated the potential absolute increase in the number of patients with a good outcome (modified Rankin Scale score ≤2) if this target had been achieved in all treated patients.

RESULTS:

Inter-hospital transfer prolonged time to ED by 140 min (95% CI 129 to 150) but reduced time from ED to treatment by 77 min (95% CI 64 to 91). Time from ED to treatment was increased by 19 min by general anesthesia (95% CI 5 to 33) and total time was increased by 23 min during off-hours (95% CI 6 to 40). The in-hospital target was achieved in 11.5% (22/192) of patients. Full compliance with the target time of 75 min from ED to treatment would have increased the proportion of patients with a good outcome by 7.6% (95% CI 6.7% to 8.5%).

CONCLUSION:

Inter-hospital transfer is an important cause of delay in the delivery of IAT and every effort should be made to avoid transfers and reduce transfer-related delay. Furthermore, in-hospital workflow should be optimized to improve functional outcome after IAT.

KEYWORDS:

stroke; thrombectomy

PMID:
28855345
DOI:
10.1136/neurintsurg-2017-013198
[Indexed for MEDLINE]

Conflict of interest statement

Competing interests: Academic Medical Center received funds from Stryker for consultations by YBWEMR and CBLMM. Erasmus University Medical Center received funds from Stryker for consultations by DWJD and AvdL, and from Bracco Imaging for consultations by DWJD. Maastricht University Medical Center received funds from Codman and Stryker for consultations by WHZ. The other authors report no conflicts.

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