Endovascular Therapy for Acute Ischemic Stroke: Reducing Door-to-puncture Time

Abstract

Objective: Reducing the time to recanalization is important for the treatment of acute ischemic stroke. We changed the treatment protocol to reduce the door-to-puncture time (DTP). In this study, we evaluated the effects of this protocol change on the treatment of ischemic stroke.Methods: Consecutive 633 patients with acute ischemic stroke were analyzed. We divided the patients into pre-protocol change and post-protocol change (359 pre-protocol changes and 274 post-protocol changes). The percentage of patients with endovascular therapy, DTP, and outcome were retrospectively compared. Results:After the protocol change, the percentage of patients with endovascular therapy in acute ischemic stroke increased (14.9 vs. 9.4%, p = 0.03), and DTP was significantly reduced (78 vs. 108 minutes, p = 0.003). No difference was observed in the outcome 90 days after the onset. Conclusion:In patients with acute ischemic stroke suspected to have major artery occlusion, DTP could be shortened by 30 minutes by informing neurointerventionalists before MRI and deciding to perform endovascular treatment and starting the setup angiography suite during MRI. It is considered vital for all members of the staff involved in stroke management to recognize the importance of early recanalization and organize a system for cooperation.