Abstract 146: Optimal Workflow and Process Based Performance Measures for Endovascular Therapy in Acute Ischemic Strokes From the Star Registry
Introduction: We report on workflow and process based performance measures and its impact on clinical outcome in STAR, a recent international, multi-center, prospective, single-arm study of Solitaire FR thrombectomy in patients with large vessel anterior circulation strokes treated within 8 hrs of symptom onset.
Methods: A total of 202 patients were enrolled across 14 comprehensive stroke centers in Europe, Canada and Australia. The following time intervals were measured: stroke onset to ED arrival; ED to baseline CT; CT to groin puncture; groin puncture to thrombus identification; thrombus identification to start of IA therapy and start of IA therapy to reperfusion. Effects of time of day, general anesthesia (GA) utilization and multi-modal imaging on workflow were evaluated. Patient characteristics and workflow processes associated with prolonged interval times and good clinical outcome (90-day mRS 0-2) were analyzed.
Results: Distribution of all interval times are illustrated in Figure 1a. Median hospital arrival to final DSA run time was 150 mins (IQR=97 mins). Hospital arrival to final DSA run time was faster in women than men (158 vs. 139 mins). General anesthesia increased CT to groin puncture time by 22 mins and groin puncture to final DSA run by 13 minutes. Time of day or week did not effect interval times. CT based multi-modal imaging reduced time from CT to groin puncture by 24 mins. For each 60-minute increase in time from symptom onset to TICI 2b/3 (or final DSA run), a 33% decrease in odds of good clinical outcome (p<0.01) was noted independent of the effect of increased age (p<0.01), higher baseline NIHSS (p=0.02), and lower ASPECTS score (p=0.02). (Figure 1b)
Conclusion: Interval times in the STAR study is a reflection of current IA therapy for patients with acute ischemic stroke. Improving workflow processes and reducing time to reperfusion could improve clinical outcomes further.
Author Disclosures: B.K. Menon: Other Research Support; Modest; HSFC, Canada; The Faculty of Medicine, University of Calgary. 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.
- © 2014 by American Heart Association, Inc.