Abstract T P2: Critical Delays In Intra-Arterial Therapy and Opportunities for Improvement
Background and purpose: It has been demonstrated that every 30-minute delay in time to revascularization is associated with 10% absolute decrease in the probability of a good outcome from intra-arterial therapy (IAT) in acute ischemic stroke (AIS) patients. We investigated the potential critical time intervals among patients with direct presentation compared to inter-hospital transfers to comprehensive stroke centers (CSCs) for IAT.
Methods: We performed a retrospective review of consecutive AIS patients who underwent IAT at 4 institutions since 2012 and abstracted symptom onset time (SOT), first emergency department arrival time (EDAT), and time of groin puncture (GP). Patients were categorized into those who were transferred from outside institutions and those who presented directly to the CSCs (non-transferred). We compared times using Mann-Whitney tests and proportions using Fisher’s exact tests.
Results: Fifty-six patients were studied (58% male, mean age 65.3 years) were studied, of which 34 (60.7%) patients were inter-hospital transfers. Of the studied time intervals, SOT to CSC arrival time in non-transferred group was significantly less than that of transferred group (78.1 vs. 271.1 min, respectively; p<0.001). Additionally, there was a trend towards reduced SOT to GP time in non-transferred group (251.4 vs. 308.5 min; p=0.059). No significant difference was observed in first EDAT to GP time between non-transferred and transferred group (199.2 vs. 215.7; p=0.11). In non-transferred group, 5 (23%), 14 (64%), and 3 (13%) patients and in transferred group 2 (6%), 26 (76%), and 6 (17%) patients achieved SOT to GP time of <3, 3-6, >6 hours, respectively (p=0.17). Additionally, first EDAT to GP time of <120 minutes was achieved in only 3 cases (5.3%).
Conclusions: Both among direct referrals and inter-hospital transfer patients, onset and initial arrival to treatment times are far from optimal. Nearly 90% of the time from onset to treatment is accounted for prior to CSC arrival among transfers while nearly 70% of the time elapses at CSCs among non-transfers. There are considerable opportunities for reducing delays in several key steps in the process including early team activation, inter-hospital transport, and rapid multimodal imaging protocols.
Author Disclosures: A.R. Honarmand: None. S. Prabhakaran: None. M. Soltanolkotabi: None. F. Feiz: None. R. Beck: None. C. Beck: None. V.H. Lee: None. J. Conners: None. M.C. Hurley: None. Y.M. Curran: None. A. Shaibani: None. S.A. Ansari: None.
- © 2014 by American Heart Association, Inc.