Abstract TP21: Did evolution of Evidence Based Stroke Thrombectomy treatment change Efficiency across Stroke Systems of Care?
Abstract only Background: Negative thrombectomy trials (IMSIII, MRRESCUE, Synsthesis expansion) resulted in very cautious selection of patients who underwent thrombectomy which probably caused delay in deciding neurointervention. With the positive results of the Big Five trials, mechanical thrombect...
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| Published in: | Stroke (1970) 2019-02, Vol.50 (Suppl_1) |
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| Main Authors: | , , , , , , |
| Format: | Article |
| Language: | eng |
| Online Access: | Get full text |
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| Summary: | Abstract only
Background:
Negative thrombectomy trials (IMSIII, MRRESCUE, Synsthesis expansion) resulted in very cautious selection of patients who underwent thrombectomy which probably caused delay in deciding neurointervention. With the positive results of the Big Five trials, mechanical thrombectomy within 6 hours became standard of care. DAWN broadened the horizon of mechanical thrombectomy to 24 hours of last known normal. To expedite mechanical thrombectomy at our community hospital we have implemented Code Neurointervention in addition to Code Stroke. Our purpose in this study is to analyse the effect of positive trials on code neurointervention time.
Methods:
All patients who received mechanical thrombectomy at our university affiliated community comprehensive stroke center from January 2014 till July 2018 were analyzed. Patients were divided in three groups: A)Pre Big Five Trials era (Jan 2014 -Dec 2014), B) Post Big five trials to pre DAWN trial (Jan 2015 - May 2017) and C) Post DAWN trial era (Jun 2017 - July 2018). We compared the time interval between Code stroke and Code Neurointervention (in minutes) among these three groups. Code stroke: time when any patient with acute neurological change within last 24 hours is encountered. Code Neurointervention: time when Vascular Neurologist and Neurointerventionalist decide to pursue endovascular therapy.
Results:
Out of 2423 ischemic stroke patients, 262 received endovascular therapy. Group A (n=38, males =18 (47%), mean age=72 years); group B (n=137, males=67 (77%), mean age=68 years); group C (n=87, males= 47 (54%), mean age=71 years). It took about about 110 minutes to decide neurointervention in group A (SD=70; 95 CI= 88 -133), 72 minutes in group B (SD= 50; 95 CI= 67-81) and 64 minutes in group C (SD=40; 95 CI =54 -73). All intergroup differences were statistically significant (p value < 0.05).
Conclusion:
Accumulation of recent evidence based data has progressively and significantly reduced the time to decision for neurointervention. Improvement in time efficiency is probably multifactorial. Larger trials are required to corroborate our findings. |
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| ISSN: | 0039-2499 1524-4628 |