Team Prenotification Reduces Procedure Times for Patients With Acute Ischemic Stroke Due to Large Vessel Occlusion Who Are Transferred for Endovascular Therapy

Lars-Peder Pallesen; Simon Winzer; Christian Hartmann; Matthias Kuhn; Johannes C Gerber; Hermann Theilen; Kevin Hädrich; Timo Siepmann; Kristian Barlinn; Jan Rahmig; Jennifer Linn; Jessica Barlinn; Volker Puetz

doi:10.3389/fneur.2021.787161

Team Prenotification Reduces Procedure Times for Patients With Acute Ischemic Stroke Due to Large Vessel Occlusion Who Are Transferred for Endovascular Therapy

Front Neurol. 2022 Jan 3:12:787161. doi: 10.3389/fneur.2021.787161. eCollection 2021.

Affiliations

¹ Department of Neurology, Dresden NeuroVascular Center, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
² Carl Gustav Carus Faculty of Medicine, Institute for Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany.
³ Institute of Neuroradiology, Dresden Neurovascular Center, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
⁴ Department of Anesthesiology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.

Abstract

Background: The clinical benefit from endovascular therapy (EVT) for patients with acute ischemic stroke is time-dependent. We tested the hypothesis that team prenotification results in faster procedure times prior to initiation of EVT. Methods: We analyzed data from our prospective database (01/2016-02/2018) including all patients with acute ischemic stroke who were evaluated for EVT at our comprehensive stroke center. We established a standardized algorithm (EVT-Call) in 06/2017 to prenotify team members (interventional neuroradiologist, neurologist, anesthesiologist, CT and angiography technicians) about patient transfer from remote hospitals for evaluation of EVT, and team members were present in the emergency department at the expected patient arrival time. We calculated door-to-image, image-to-groin and door-to-groin times for patients who were transferred to our center for evaluation of EVT, and analyzed changes before (-EVT-Call) and after (+EVT-Call) implementation of the EVT-Call. Results: Among 494 patients in our database, 328 patients were transferred from remote hospitals for evaluation of EVT (208 -EVT-Call and 120 +EVT-Call, median [IQR] age 75 years [65-81], NIHSS score 17 [12-22], 49.1% female). Of these, 177 patients (54%) underwent EVT after repeated imaging at our center (111/208 [53%) -EVT-Call, 66/120 [55%] +EVT-Call). Median (IQR) door-to-image time (18 min [14-22] vs. 10 min [7-13]; p < 0.001), image-to-groin time (54 min [43.5-69.25] vs. 47 min [38.3-58.75]; p = 0.042) and door-to-groin time (74 min [58-86.5] vs. 60 min [49.3-71]; p < 0.001) were reduced after implementation of the EVT-Call. Conclusions: Team prenotification results in faster patient assessment and initiation of EVT in patients with acute ischemic stroke. Its impact on functional outcome needs to be determined.

Keywords: large-vessel occlusion; stroke; telemedicine; thrombectomy; work-flow.