Abstract 98: Higher Volume Endovascular Stroke Centers Have Decreased Times to Treatment
Background: Currently, no metric exists for door to arterial puncture time for endovascular treatment in acute ischemic stroke. The aim of this study was to determine the timings of each step of endovascular stroke intervention stratified by the volume of procedures at each center.
Methods: We retrospectively reviewed patients from seven institutions undergoing endovascular reperfusion therapies for acute ischemic stroke. Patients with anterior circulation strokes treated less than 8 hours from symptoms onset were included. Demographic, radiographic, angiographic and clinical outcomes were collected. The time interval at each milestone from CT acquisition to reperfusion was recorded. Successful reperfusion was defined as achieving a TICI 2B or 3 score as graded by the operator. Symptomatic hemorrhage was defined as a parenchymal hemorrhage type 2 as defined by ECASScriteria. Centers that performed more than 50 intra-arterial stroke interventions annually were considered high volume (HV) centers. A univariate analysis was performed with the Fisher’s exact test for categorical variables and students t-test for continuous variables to compare HV to lower volume (LV) centers. Variables with a p-value < 0.20 were placed in a binary logistic regression model to determine if there were differences in time to treatment between the two groups.
Results: A total of 338 patients with a mean age of 67±14 years and mean NIHSS of 18±5 were included. The mean time from CT imaging to groin puncture was 108±73 minutes. The mean time from groin puncture to the placement of a microcatheter in the thrombus was 41±21 minutes and total procedure time 104±55 minutes. There were no differences in demographics, site of vascular occlusion and hemorrhage rates between high volume and lower volume centers. In univariate analysis, HV centers had a lower time from CT imaging to groin puncture (89±57 minutes vs. 154±84 minutes, p<0.001), procedure time (93±46 minutes vs. 129±65 minutes, p<0.001), final infarct volume (79±82 cm3 vs. 94±106 cm3, p<0.03) and higher reperfusion rates (73% vs. 59%, p<0.01). In binary logistic regression modeling HV centers were found to have a shorter CT acquisition to arterial puncture time [OR 0.991, 95%CI (0.986-0.996), p<0.001] and higher reperfusion rates [OR 1.79, 95% CI (1.04-3.12), p<0.03].
Conclusions: Currently there is variability in the time from CT to arterial puncture and total procedure time across institutions, but HV centers appear to have lower times to treatment. Further study is required to determine how to reduce times to treatment and develop a metric for centers to target.
- © 2012 by American Heart Association, Inc.