Streamlining door to recanalization processes in endovascular stroke therapy

Aghaebrahim, Amin; Streib, Christopher; Rangaraju, Srikant; Kenmuir, Cynthia L.; Giurgiutiu, Dan‐Victor; Horev, Anat; Saeed, Yumna; Callaway, Clifton W.; Guyette, Francis X.; Martin-Gill, Chris; Pacella, Charissa; Ducruet, Andrew F; Jankowitz, Brian T.; Jovin, Tudor G; Jadhav, Ashutosh P.

doi:10.1136/neurintsurg-2016-012324

Cited by 69 publications

(50 citation statements)

References 27 publications

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“…Studies have shown that median or mean door-to-imaging times of ≤20 minutes can be achieved in a variety of different hospital settings. [74][75][76] See Table XVI in online Data Supplement 1. …”

mentioning

confidence: 99%

2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

Powers¹,

Rabinstein²,

Ackerson³

et al. 2018

Stroke

4,392

2,535

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Background and Purpose-The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations for clinicians caring for adult patients with acute arterial ischemic stroke in a single document. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 guidelines and subsequent updates. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained. Members were not allowed to participate in discussions or to vote on topics relevant to their relations with industry. The members of the writing group unanimously approved all recommendations except when relations with industry precluded members voting. Prerelease review of the draft guideline was performed by 4 expert peer reviewers and by the members of the Stroke Council's Scientific Statements Oversight The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. Guidelines for the Early Management of PatientsThis guideline was approved by the American Heart Association Science Advisory and Coordinating Committee on November 29, 2017, and the American Heart Association Executive Committee on December 11, 2017. A copy of the document is available at http://professional.heart.org/statements by using either "Search for Guidelines & Statements" or the "Browse by Topic" area. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@ wolterskluwer.com. Tables) is available The American Heart Association requests that this document be cited as follows: Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL; on behalf of the American Heart Association Stroke Council. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49:eXXXeXXX. doi: 10.1161/STR.0000000000000158. Data Supplement 1 (EvidenceThe expert peer review of AHA-commissioned documents (eg, scientific statements, clinical practice guidelines, systematic reviews) is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://professional.heart.org/statements. Select the "Guidelines & Statem...

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mentioning

confidence: 99%

2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

Powers¹,

Rabinstein²,

Ackerson³

et al. 2018

Stroke

4,392

2,535

View full text Add to dashboard Cite

show abstract

“…8 With an emphasis on parallel workflow, preset time goals, and continuous feedback, several centers have now demonstrated improved treatment times with quality-initiative projects. 17,18 Based on their meta-analysis, Saver et al 8 advocate for the following time metrics: 50 minutes for brain imaging-to-arterial puncture time, 75 minutes for ED door-to-arterial puncture time, and 110 minutes for ED door-to-reperfusion time.…”

Section: Discussionmentioning

confidence: 99%

Interfacility Transfer Directly to the Neuroangiography Suite in Acute Ischemic Stroke Patients Undergoing Thrombectomy

Jadhav

Kenmuir

Aghaebrahim

et al. 2017

Stroke

Self Cite

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Background and Purpose-In patients identified at referring facilities with acute ischemic stroke caused by a large vessel occlusion, bypassing the emergency department (ED) with direct transport to the neuroangiography suite may safely shorten reperfusion times. Methods-We conducted a single-center retrospective review of consecutive patients transferred to our facility for consideration of endovascular therapy. Patients were identified as admitted directly to the neuroangiography suite (DAN), transferred to the ED before intra-arterial therapy (ED-IA), and transferred to the ED but did not receive IA therapy (ED-IV). Results-A retrospective review of a prospectively maintained database of transfer patients between January 2013 and October 2016 with large vessel occlusions identified 108 ED-IV patients and 261 patients who underwent mechanical thrombectomy (DAN=111 patients and ED-IA=150 patients). There were no differences in baseline characteristics among the 3 groups. The median computed tomography ASPECTS (Alberta Stroke Program Early CT Score) was lower in the ED-IV group versus the ED-IA and DAN groups (8 versus 9; P=0.001). In the DAN versus ED-IA cohort, there were comparable rates of TICI2b/3 recanalization and access to recanalization time. There was significantly faster hospital arrival to groin access time in the DAN cohort (81 minutes versus 22 minutes; P=0.001). Functional independence at 90 days was comparable in the DAN versus ED-IA cohorts but worse in the ED-IV group (43% versus 44% versus 22%; P=0.001). Conclusions-DAN is safe, feasible, and associated with faster times of hospital arrival to recanalization. The clinical benefit of this approach should be assessed in a prospective randomized trial.

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“…This has also held true in the modern embolectomy era 7. Workflow optimization to ensure rapid triage of patients with severe stroke and efficient in-hospital processes are vital to optimize time to angiography 8 9. Our aim was to standardize what happened intraprocedurally once the patient arrived in the angiography suite and to examine how this impacted time from groin puncture to first deployment and recanalization.…”

Section: Introductionmentioning

confidence: 99%

Decreasing procedure times with a standardized approach to ELVO cases

McTaggart

Yaghi

Baird

et al. 2016

J NeuroIntervent Surg

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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.

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Streamlining door to recanalization processes in endovascular stroke therapy

Cited by 69 publications

References 27 publications

2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

Interfacility Transfer Directly to the Neuroangiography Suite in Acute Ischemic Stroke Patients Undergoing Thrombectomy

Decreasing procedure times with a standardized approach to ELVO cases

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