title: Mechanical thrombectomy for anterior circulation stroke: 5-year experience in a statewide service with differences in pretreatment time metrics across two hospitals sites.
abstract: OBJECTIVE
  To audit our institutional mechanical thrombectomy (MT) outcomes for acute anterior circulation stroke and examine the influence of workflow time metrics on patient outcomes.
  
  
  METHODS
  A database of 100 MT cases was maintained throughout May 2010-February 2015 as part of a statewide service provided across two tertiary hospitals (H1 and H2). Patient demographics, stroke and procedural details, blinded angiographic outcomes, and 90-day modified Rankin Scale (mRS) scores were recorded. The following time points in stroke treatment were recorded: stroke onset, hospital presentation, CT imaging, arteriotomy, and recanalization. Statistical analysis of outcomes, predictors of outcome, and differences between the hospitals was carried out.
  
  
  RESULTS
  Thrombolysis in Cerebral Infarction (TICI) 2b/3 reperfusion was 79%. Forty-nine per cent of patients had good clinical outcomes (mRS 0-2). In a subgroup analysis of 76 patients with premorbid mRS 0-1 and first CT performed ≤4.5 h after stroke onset, 60% had good clinical outcomes. Patient and disease characteristics were matched between the two hospitals. H1 had shorter times between hospital presentation and CT (32 vs 55 min, p=0.01), CT and arteriotomy (33 vs 69 min, p=0.00), and stroke onset and recanalization (198 vs 260 min, p=0.00). These time metrics independently predicted good clinical outcome. Median days spent at home in the first 90 days was greater at H1 (61 vs 8, p=0.04) than at H2. A greater proportion of patients treated at H1 were independent (mRS 0-2) at 90 days (54% vs 42%); however, this was not statistically significant (p=0.22).
  
  
  CONCLUSIONS
  Outcomes similar to randomized controlled trials are attainable in 'real-world' settings. Workflow time metrics were independent predictors of clinical outcome, and differed between the two hospitals owing to site-specific organizational differences.
authors.affiliation: Neurological Intervention and Imaging Service of Western Australia (NIISWA), Perth, Western Australia, Australia.
authors.forename: Ruchi
authors.identifier: http://orcid.org/0000-0002-1809-491X
authors.initials: R
authors.lastname: Kabra
authors.affiliation: Neurological Intervention and Imaging Service of Western Australia (NIISWA), Perth, Western Australia, Australia.
authors.forename: Timothy J
authors.identifier: http://orcid.org/0000-0001-9023-5986
authors.initials: TJ
authors.lastname: Phillips
authors.affiliation: Department of Neurology, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Jacqui-Lyn
authors.identifier: http://orcid.org/0000-0003-1180-7929
authors.initials: JL
authors.lastname: Saw
authors.affiliation: Neurological Intervention and Imaging Service of Western Australia (NIISWA), Perth, Western Australia, Australia.
authors.forename: Constantine C
authors.identifier: http://orcid.org/0000-0002-2384-018X
authors.initials: CC
authors.lastname: Phatouros
authors.affiliation: Neurological Intervention and Imaging Service of Western Australia (NIISWA), Perth, Western Australia, Australia.
authors.forename: Tejinder P
authors.identifier: http://orcid.org/0000-0002-5448-7008
authors.initials: TP
authors.lastname: Singh
authors.affiliation: Department of Neurology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
authors.forename: Graeme J
authors.identifier: http://orcid.org/0000-0002-6044-7328
authors.initials: GJ
authors.lastname: Hankey
authors.affiliation: Department of Neurology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
authors.forename: David
authors.identifier: http://orcid.org/0000-0003-0046-9776
authors.initials: D
authors.lastname: Blacker
authors.affiliation: Department of Neurology, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Darshan
authors.identifier: http://orcid.org/0000-0003-0518-5887
authors.initials: D
authors.lastname: Ghia
authors.affiliation: Department of Neurology, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: David
authors.identifier: http://orcid.org/0000-0001-7301-2887
authors.initials: D
authors.lastname: Prentice
authors.affiliation: Neurological Intervention and Imaging Service of Western Australia (NIISWA), Perth, Western Australia, Australia.
authors.forename: William
authors.identifier: http://orcid.org/0000-0001-9462-441X
authors.initials: W
authors.lastname: McAuliffe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015424:Reperfusion; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D062606:Tertiary Care Centers / Q000639:trends*; D017131:Thrombectomy / Q000379:methods / Q000639:trends*; D061665:Time-to-Treatment / Q000639:trends*; D016896:Treatment Outcome
keywords: Standards; Stroke; Thrombectomy