A standardized neurointerventional thrombectomy protocol leads to faster recanalization times

Abstract

Background and purpose 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 MannWhitney 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.

Latest generation of flat detector CT as a peri-interventional diagnostic tool: a comparative study with multidetector CT

“…However, only 13% and 4% of the randomized patients were treated within the ‘ideal’ SNIS 2015 intervals of ≤60 min for door to groin time and ≤30 min for imaging to groin time. 13 Even with a streamlined process, Frei et al 14 recently reported a median door to groin time of 71 min for direct admission patients undergoing triage with MDCT.…”

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

“…Preliminary data show a further significant reduction of time from admission to reperfusion compared to other studies proposing a streamlined patient management 11 . Patients not meeting the criteria required for the one stop management approach, i.e.…”

Consensus Statements by Korean Society of Interventional Neuroradiology and Korean Stroke Society: Hyperacute Endovascular Treatment Workflow to Reduce Door-to-Reperfusion Time

“… 39 In parallel, the nurse and NI technologist prepare the angiography suite for the upcoming thrombectomy procedure. 40 This team-based approach resulted in a marked reduction in the treatment time and increase in the number of patients successfully treated in the American Heart Association's Best Practice Strategies. 41 …”

“…A standardized stroke kit, so called BRISK (brisk recanalization ischemic stroke kit), was used in a previous report for time-saving process improvement. 40 All NI team members should be well-acquainted with the exact location of the prepared EVT kit and standardized stroke kit in the angiography suite for rapid deployment. Similarly, all members should be familiar with tasks for thrombectomy procedure so that critical functions are duplicated and replaced.…”