Abstract 143: Evaluation of Interval Times from Onset to Recanalization in Patients Undergoing Endovascular Therapy in the IMS III Trial
Background: There were significant delays in achieving recanalization observed in the IA arm of IMS III. A detailed analysis of the workflow helps to identify factors contributing to overall delay.
Methods: In 418 subjects randomized to the IA arm, the following time intervals were calculated: stroke onset to ED arrival; ED to CT; CT to start of IV tPA; IV tPA to randomization; randomization to groin puncture; groin puncture to thrombus identification; thrombus identification to start of IA therapy; start of IA therapy to reperfusion. The effects of time of day and general anesthesia (GA) on workflow were evaluated. The change of ED to reperfusion and groin puncture to reperfusion over the study period were also evaluated. All times are reported as medians (with IQR).Kruskal-Wallis test was applied.
Results: Time intervals are shown in figure 1. Intubation had no significant effect on the overall workflow time. The time from CT to groin puncture during business hours (Mon-Fri; 0800-1700) was 119 min (n=201; IQR 49 min) and after hours was 141 min (n=203; IQR 54 min, p <0.0001). The time from CT to groin puncture during day time (0800-2100) was 127 min (n=341; IQR: 51 min) and during night time was 142 min (n=63; IQR 60 min, p=0.0012). After adjusting for multiple comparisons (Bonferroni method), the times from ED to reperfusion (316 min in 1st quartile to 246 min in last quartile,p<0.0001), and groin puncture to reperfusion (145 min in 1st quartile to 120 min in last quartile;p=0.0005) decreased over the trial duration.
Conclusion: In the endovascular arm of the IMS III trial there were significant delays from start of IV tPA to groin puncture. Endovascular techniques used in the trial were quite inefficient in achieving recanalization. Use of GA did not result in additional delays. Endovascular treatment outside of daytime hours did result in slight additional delays. These data may help in designing, optimizing and documenting workflow in current and future endovascular trials.
Author Disclosures: M. Goyal: Speakers' Bureau; Modest; Covidien EV3. Research Grant; Significant; Institutional grant for ESCAPE trial from Covidien EV3. Consultant/Advisory Board; Significant; Covidien EV3 for help with design and execution of SWIFT PRIME. B. Menon: None. L. Fan: None. A. Demchuk: Other; Modest; Grant support and lecture fees Covidien. S. Yeatts: None. M. Hill: Research Grant; Modest; Hoffman-La Roche Canada. Consultant/Advisory Board; Modest; Vernalis Group. Other; Modest; Lefture fees Hoffman-La Roche Canada, Stock options Calgary Scientific, Heart and Stroke Foundation of , Northwest Territories and Nunavut. T. Tomsick: Research Grant; Modest; Covidien. P. Khatri: Expert Witness; Modest; Medico-Legal Consulting. Consultant/Advisory Board; Modest; Penumbra, Genentech, Janssen Pharmaceuticals. Other; Modest; Travel support Genentech. O. Zaidat: Honoraria; Modest; penumbra, stryker, microvention, EV3, codman. Consultant/Advisory Board; Modest; penumbra, stryker, microvention, EV3, codman. E. Jauch: None. T.G. Jovin: Consultant/Advisory Board; Modest; Silk Road Medical. Other; Modest; Stock options Silk Road Medical. J.P. Broderick: Other Research Support; Modest; Novo Nordisk. Consultant/Advisory Board; Modest; Pfizer, Inc..
- © 2014 by American Heart Association, Inc.