Previous studies have shown that faster Door to Needle (DTN) treatment times are associated with better outcomes for acute ischemic stroke patients. With the continued push for faster times, we aimed to determine if DTN treatment times in the 30- vs 45-minute time window yielded statistically significant differences in outcomes or complications. Data obtained from a multi-state stroke registry included acute ischemic stroke patients ≥18 years of age discharged between January 2017 and April 2020, and treated with IV alteplase with DTN times between 25-30 or 40-45 minutes. Outcomes were 90-day Modified Rankin Score (mRS) (0-2 vs 3-6), discharge disposition [home or inpatient rehabilitation facility (IRF) vs other location], complications (any treatment-related complication vs none), and hospital length of stay (LOS). Patients with a documented reason for delay or who received thrombectomy were excluded. Outcomes of patients with 25- to 30-minute DTN times were compared to those with 40- to 45-minute DTN times using generalized linear models and multiple linear regression, adjusting for admission NIHSS, age, gender, race/ethnicity, and medical history. Compared to the 20-25 minute group, patients treated in the 40-45 minute window had higher odds of a documented 90-day mRS of 3 or more (Adjusted Odds Ratio (AOR)=1.19, p=0.253, n=201 ) and treatment-related complication (AOR=1.35, p=0.569) and lower odds of discharge to home or IRF (AOR=0.846, p=0.359). There was little difference in LOS (β=-0.008, p=0.847). None of the outcomes reached statistical significance. Administering alteplase in the 25- to 30-minute window is safe and did not result in an increase in bleeding complications. Although faster treatment times trended toward better outcomes, there was no statistically significant difference between the 25-30 and 40-45 minute DTN treatment times.
Background: Reducing treatment time for ischemic stroke is crucial. In 2017, an urban Comprehensive Stroke Center (CSC) in the Pacific Northwest (PNW) initiated early activation of the interventional radiology team (Early-IR) based on first responder LAMS’ score of 4 or 5 to improve thrombectomy treatment times (door-to-arterial access times [DTAA]) for acute ischemic stroke patients. Policy efficacy has not been evaluated. Objectives: 1) Compare DTAA times and clinical outcomes pre vs post Early-IR initiation using a multi-state stroke registry. 2) Compare DTAA times and clinical outcomes between the PNW and other CSCs in the same multi-state stroke registry. Methods: Included ischemic stroke patients arrived via emergency medical services from 01/01/2015 to 03/30/2020 at PNW CSC and from 05/15/2017 to 03/31/2020 at five other CSCs. Mann-Whitney U test and multiple linear regression were used to compare DTAA among patients arriving Pre-Early IR vs Post-Early IR at PNW and then to compare PNW vs other CSCs during the Post-Early IR phase. Discharge disposition and ambulation were compared using Pearson’s chi-squared tests. Models were adjusted for admission NIHSS, age, gender, race, IV tPA treatment, comorbidities and medications at admission. Results: A total of 156 PNW patients were included in the primary analysis, 32.1 % (n=50) in the Pre- and 67.9% (n=106) in the Post-Early IR groups. Bivariate analyses showed DTAA was faster Post-Early IR (131 minutes vs 92 minutes, p<.001) and remained faster after adjusting for covariates (B=-.500, p <.001). Early IR did not significantly impact discharge disposition ( p =.620) or ambulation ( p =.995) (Table 1). Comparing the PNW to five other CSCs during the Post-Early IR period showed no significant difference in DTAA or secondary outcomes (Table 1). Conclusion: Early IR decreased thrombectomy treatment initiation times for ischemic stroke patients at the PNW CSC.
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