title: Evaluation of interval times from onset to reperfusion in patients undergoing endovascular therapy in the Interventional Management of Stroke III trial.
abstract: BACKGROUND
  Meaningful delays occurred in the Interventional Management of Stroke (IMS) III trial. Analysis of the work flow will identify factors contributing to the in-hospital delays.
  
  
  RESULTS
  In the endovascular arm of the IMS III trial, the following time intervals were calculated: stroke onset to emergency department arrival; emergency department to computed tomography (CT); CT to intravenous tissue plasminogen activator start; intravenous tissue plasminogen activator start to randomization; randomization to groin puncture; groin puncture to thrombus identification; thrombus identification to start of endovascular therapy; and start of endovascular therapy to reperfusion. The effects of enrollment time, CT angiography use, interhospital transfers, and intubation on work flow were evaluated. Delays occurred notably in the time intervals from intravenous tissue plasminogen activator initiation to groin puncture (median 84 minutes) and start of endovascular therapy to reperfusion (median 85 minutes). The CT to groin puncture time was significantly shorter during working hours than after. Times from emergency department to reperfusion and groin puncture to reperfusion decreased over the trial period. Patients with CT angiography had shorter emergency department to reperfusion and onset to reperfusion times. Transfer of patients resulted in a longer onset to reperfusion time compared with those treated in the same center. Age, sex, National Institutes of Health Stroke Scale score, and intubation did not affect delays.
  
  
  CONCLUSIONS
  Important delays were identified before reperfusion in the IMS III trial. Delays decreased as the trial progressed. Use of CT angiography and endovascular treatment in the same center were associated with time savings. These data may help in optimizing work flow in current and future endovascular trials.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00359424.
authors.affiliation: Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.). mgoyal@ucalgary.ca.
authors.forename: Mayank
authors.initials: M
authors.lastname: Goyal
authors.affiliation: Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.).
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Almekhlafi
authors.affiliation: Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.).
authors.forename: Liqiong
authors.initials: L
authors.lastname: Fan
authors.affiliation: Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.).
authors.forename: Bijoy K
authors.initials: BK
authors.lastname: Menon
authors.affiliation: Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.).
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
authors.affiliation: Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.).
authors.forename: Sharon D
authors.initials: SD
authors.lastname: Yeatts
authors.affiliation: Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.).
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
authors.affiliation: Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.).
authors.forename: Thomas
authors.initials: T
authors.lastname: Tomsick
authors.affiliation: Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.).
authors.forename: Pooja
authors.initials: P
authors.lastname: Khatri
authors.affiliation: Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.).
authors.forename: Osama O
authors.initials: OO
authors.lastname: Zaidat
authors.affiliation: Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.).
authors.forename: Edward C
authors.initials: EC
authors.lastname: Jauch
authors.affiliation: Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.).
authors.forename: Muneer
authors.initials: M
authors.lastname: Eesa
authors.affiliation: Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.).
authors.forename: Tudor G
authors.initials: TG
authors.lastname: Jovin
authors.affiliation: Departments of Radiology and Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (M.G., M.A.A., B.K.M., A.M.D., M.D.H., M.E.); Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (M.A.A.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.F., S.D.Y.); Departments of Neurology and Radiology, University of Cincinnati, Cincinnati, OH (T.T., P.K., J.P.B.); Department of Radiology, Medical College of Wisconsin, Milwaukee (O.O.Z.); Division of Emergency Medicine, Medical University of South Carolina, Charleston (E.C.J.); and Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (T.G.J.).
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Broderick
mesh_terms: D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D010360:Patient Transfer; D015424:Reperfusion / Q000379:methods*; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D057188:Workflow
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: cerebrovascular disease; infarction; stroke