title: "No turn back approach" to reduce treatment time for endovascular treatment of acute ischemic stroke.
abstract: BACKGROUND
  A delay in endovascular treatment is less likely if acute ischemic stroke patients proceed from emergency department (ED) to computed tomographic (CT) scanner and directly to angiographic suite (no turn back approach). We determined the feasibility of the "no turn back approach" and its effect on treatment times and patient outcomes.
  
  
  METHODS
  The primary outcomes were procedures performed with a time interval: (1) between ED arrival and microcatheter placement of less than 120 minutes and (2) between CT scan acquisition and microcatheter placement of less than 90 minutes. We determined the effect of the no turn back approach on favorable outcome at discharge.
  
  
  RESULTS
  There was a significantly higher rate of CT scan acquisition and microcatheter placement time of less than 90 minutes in patients in whom no turn back approach was used (57.6% versus 31.6%, P = .0007). There was a significantly higher rate of ED arrival to microcatheter placement time of less than 120 minutes in patients in whom no turn back approach was used (31.8% versus 13.7%, P = .004). In the exploratory analysis, there was a trend toward higher rate of favorable outcomes (odds ratio 1.6, 95% confidence interval .9-2.8, P = .07) among those treated with no turn back approach after adjusting for age, admission National Institutes of Health Stroke Scale score strata, congestive heart failure, and diabetes mellitus.
  
  
  CONCLUSIONS
  The no turn back approach appeared to be feasible and reduced the time interval between ED arrival and microcatheter placement in acute ischemic stroke patients undergoing endovascular treatment.
authors.affiliation: Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi
authors.affiliation: Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Hossam
authors.initials: H
authors.lastname: Egila
authors.affiliation: Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota. Electronic address: malikmuhammad.adil@gmail.com.
authors.forename: Malik M
authors.initials: MM
authors.lastname: Adil
authors.affiliation: Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Harris
authors.initials: H
authors.lastname: Siddiqi
authors.affiliation: Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Nidaullah
authors.initials: N
authors.lastname: Mian
authors.affiliation: Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Ameer E
authors.initials: AE
authors.lastname: Hassan
authors.affiliation: Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Jefferson T
authors.initials: JT
authors.lastname: Miley
authors.affiliation: Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Gustavo J
authors.initials: GJ
authors.lastname: Rodriguez
authors.affiliation: Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota.
authors.forename: M Fareed K
authors.initials: MF
authors.lastname: Suri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000628:therapy*; D016009:Chi-Square Distribution; D019091:Critical Pathways; D004185:Disability Evaluation; D004636:Emergency Service, Hospital; D057510:Endovascular Procedures / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D016017:Odds Ratio; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D013997:Time Factors; D061665:Time-to-Treatment; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Ischemic stroke; endovascular treatment; microcatheter; thrombectomy; treatment time