Menon, Bijoy K; Almekhlafi, Mohammed A; Pereira, Vitor Mendes; Gralla, Jan; Bonafe, Alain; Davalos, Antoni; Chapot, Rene; Goyal, Mayank (2014). Optimal Workflow and Process-Based Performance Measures for Endovascular Therapy in Acute Ischemic Stroke: Analysis of the Solitaire FR Thrombectomy for Acute Revascularization Study. Stroke, 45(7), pp. 2024-2029. Lippincott Williams & Wilkins 10.1161/STROKEAHA.114.005050
Full text not available from this repository.BACKGROUND AND PURPOSE
We report on workflow and process-based performance measures and their effect on clinical outcome in Solitaire FR Thrombectomy for Acute Revascularization (STAR), a multicenter, prospective, single-arm study of Solitaire FR thrombectomy in large vessel anterior circulation stroke patients.
METHODS
Two hundred two patients were enrolled across 14 centers in Europe, Canada, and Australia. The following time intervals were measured: stroke onset to hospital arrival, hospital arrival to baseline imaging, baseline imaging to groin puncture, groin puncture to first stent deployment, and first stent deployment to reperfusion. Effects of time of day, general anesthesia use, and multimodal imaging on workflow were evaluated. Patient characteristics and workflow processes associated with prolonged interval times and good clinical outcome (90-day modified Rankin score, 0-2) were analyzed.
RESULTS
Median times were onset of stroke to hospital arrival, 123 minutes (interquartile range, 163 minutes); hospital arrival to thrombolysis in cerebral infarction (TICI) 2b/3 or final digital subtraction angiography, 133 minutes (interquartile range, 99 minutes); and baseline imaging to groin puncture, 86 minutes (interquartile range, 24 minutes). Time from baseline imaging to puncture was prolonged in patients receiving intravenous tissue-type plasminogen activator (32-minute mean delay) and when magnetic resonance-based imaging at baseline was used (18-minute mean delay). Extracranial carotid disease delayed puncture to first stent deployment time on average by 25 minutes. For each 1-hour increase in stroke onset to final digital subtraction angiography (or TICI 2b/3) time, odds of good clinical outcome decreased by 38%.
CONCLUSIONS
Interval times in the STAR study reflect current intra-arterial therapy for patients with acute ischemic stroke. Improving workflow metrics can further improve clinical outcome.
CLINICAL TRIAL REGISTRATION: URL
http://www.clinicaltrials.gov. Unique identifier: NCT01327989.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology |
UniBE Contributor: |
Gralla, Jan |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
0039-2499 |
Publisher: |
Lippincott Williams & Wilkins |
Language: |
English |
Submitter: |
Martin Zbinden |
Date Deposited: |
10 Oct 2014 22:24 |
Last Modified: |
05 Dec 2022 14:35 |
Publisher DOI: |
10.1161/STROKEAHA.114.005050 |
PubMed ID: |
24876244 |
Uncontrolled Keywords: |
cerebrovascular accident, emergency stroke |
URI: |
https://boris.unibe.ch/id/eprint/54020 |
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