A standardized neurointerventional thrombectomy protocol leads to faster recanalization times.
OBJECTIVE
Intra-arterial therapy (IAT) is most effective when performed rapidly after ischemic stroke onset. However, there are limited performance benchmarks in IAT and there is a scarcity of information on how to structure an effective IAT protocol and its impact on time to treatment. The objective of our study was to detail a standardized IAT protocol, and to assess its influence on time to treatment in ischemic stroke.


METHODS
This was a retrospective observational study over 4 years at a comprehensive stroke center. A standardized IAT protocol was implemented in June 2013 that included pre-notifying the stroke team before hospital arrival, defining clinician roles, processing tasks in parallel, and standardizing IAT procedures. Three time metrics were examined and reported as median (IQR) minutes: arrival to CT imaging, CT to groin puncture, and puncture to recanalization. We compared these metrics in patients admitted before implementation (January 2012-May 2013) to patients admitted after (June 2013-December 2015) using Wilcoxon Mann-Whitney tests.


RESULTS
380 patients were included. After the protocol was implemented, there were significant reductions in time from arrival to CT (17 (14-21) vs 13 (11-19) min, p<0.001), CT to puncture (46 (30-82) vs 31 (23-54) min, p<0.001), and puncture to recanalization (65 (33-90) vs 37 (22-65) min, p<0.001). 60% of time was saved during puncture to recanalization. Significant reductions in time were observed during both normal working hours and off-hours.


CONCLUSIONS
Implementation of a standardized protocol resulted in a significant reduction in time to recanalization for patients with an ischemic stroke. A standardized IAT protocol decreases time to recanalization when team roles are clearly defined, tasks are processed in parallel, and procedures are standardized.
Radiology Imaging Associates PC, Englewood, Colorado, USA.
Donald
D
Frei
Trauma Research LLC, Swedish Medical Center, Englewood, Colorado, USA.
Constance
C
McGraw
Department of Neurology, Swedish Medical Center, Englewood, Colorado, USA.
Kathryn
K
McCarthy
Department of Neurology, Swedish Medical Center, Englewood, Colorado, USA.
Michelle
M
Whaley
Radiology Imaging Associates PC, Englewood, Colorado, USA.
Richard J
RJ
Bellon
Radiology Imaging Associates PC, Englewood, Colorado, USA.
David
D
Loy
Department of Neurology, Swedish Medical Center, Englewood, Colorado, USA.
Jeff
J
Wagner
Trauma Research LLC, Swedish Medical Center, Englewood, Colorado, USA.
Alessandro
A
Orlando
Trauma Research LLC, Swedish Medical Center, Englewood, Colorado, USA.
David
D
Bar-Or
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000628:therapy*; D057510:Endovascular Procedures / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011677:Punctures; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods / Q000592:standards*; D015912:Thrombolytic Therapy / Q000379:methods / Q000592:standards; D013997:Time Factors; D061665:Time-to-Treatment / Q000592:standards*; D016896:Treatment Outcome; D055815:Young Adult
Intervention; Stroke; Thrombectomy