title: Decreasing procedure times with a standardized approach to ELVO cases.
abstract: BACKGROUND
  Embolectomy is the standard of care for emergent large vessel occlusion (ELVO), and needs to be done as quickly as possible for the best possible outcomes. Optimization of workflow and process is certainly paramount. One aspect of this is process improvement to standardize as much as possible the procedure in order to decrease variability among operators, which breeds familiarity for the entire team.
  
  
  OBJECTIVE
  To evaluate the impact of a standardized approach to ELVO cases in decreasing times from groin puncture to first deployment of a stent-retriever and final recanalization.
  
  
  METHODS
  A retrospective review of 83 consecutive patients consisting of a pre-standardization phase (group 1) and those after standardization (group 2). The standardization process involved all three neurointerventional radiologists agreeing on a standard approach to the cases and to the equipment to be used. Times from groin puncture to first deployment of the stent-retriever and from puncture to final reperfusion were evaluated. Angiographic outcomes were scored using the Modified Thrombolysis in Cerebral Ischemia (mTICI) score. Complications from intracranial catheter manipulation (such as wire perforation) were also recorded. Clinical outcomes were assessed based on admission and discharge National Institute of Health Stroke Scale score.
  
  
  RESULTS
  There were 22 patients in group 1 and 61 patients in group 2. Mean times from groin puncture to first deployment were 39.8 min in group 1 and 20 min in group 2, a difference which was statistically significant (p<0.0001). Overall times from puncture to final recanalization were reduced from 68.2 to 37 min, also a statistically significant difference (p<0.001). There were no cases of intraprocedural complications such as wire perforation or subarachnoid hemorrhage.
  
  
  CONCLUSIONS
  A standardized approach to the equipment used and process for ELVO cases at a single institution can dramatically reduce procedure times.
authors.affiliation: Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.
authors.forename: Ryan A
authors.initials: RA
authors.lastname: McTaggart
authors.affiliation: Department of Neurology, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.
authors.forename: Shadi
authors.initials: S
authors.lastname: Yaghi
authors.affiliation: Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.
authors.forename: Grayson
authors.identifier: http://orcid.org/0000-0002-5926-9886
authors.initials: G
authors.lastname: Baird
authors.affiliation: Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.|Department of Neurosurgery, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Haas
authors.affiliation: Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.|Department of Neurology, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.|Department of Neurosurgery, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.
authors.forename: Mahesh V
authors.initials: MV
authors.lastname: Jayaraman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000601:surgery; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000601:surgery; D017128:Embolectomy / Q000379:methods*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015424:Reperfusion; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000601:surgery; D017131:Thrombectomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Stroke