Abstract W P223: Systems wide Streamlining of Door to Recanalization Processes in Endovascular Stroke Therapy
Objective: Faster reperfusion leads to better outcome both in thrombolytic therapy and endovascular therapy in acute stroke. We analyzed the effect of interventions aimed to reduce treatment delays in our single-center prospective series.
Methods: All consecutive ischemic stroke patients treated with endovascular therapy were prospectively registered from 4/20/12 to 7/29/14. We divided the patients into pre-intervention (4/20/12-10/8/13) and post-intervention (10/9/13-7/29/14) period. The main interventions included: awareness, continuous feedback and regular education of staff involved, EMS pre notification, protocolized immediate direct ED attending to stroke attending communication, direct IR activation by stroke team including for possible rather than certain intervention, direct patient transportation by EMS to CT scanner, direct transportation of patient from CT scanner to angiosuite, direct transport from outside hospital to angiosuite.
Results: See table. There was no significant difference between the demographics, location of the occlusion, rate of IV tpa, or revascularization rate between the groups with the exception of better ASPECT in pre-intervention group (P=0.034). Compared to pre-intervetion, time delays were improved at virtually every step. Median door-to-puncture (D2P) improved from 105 minutes to 67 minutes post-intervention which was significant (p=0.006). Despite time to perfusion improvement, there was no significant difference in rate of 3 month good outcome which is most likely due to small sample size.
Conclusions: This pilot study demonstrates that D2P times can be dramatically lowered with a few simple measures. Larger prospective studies will be necessary to determine whether these interventions will translate into improved clinical outcomes.
Author Disclosures: A. Aghaebrahim: None. A. Jadhav: None. C. Kenmuir: None. D. Giurgiutiu: None. A. Horev: None. Y. Saeed: None. C. Callaway: None. F. Guyette: None. A. Ducruet: None. B. Jankowitz: None. C. Pacella: None. T. Jovin: None.
- © 2015 by American Heart Association, Inc.