Time Metrics to Endovascular Thrombectomy in 3 Triage Concepts

Author:

Seker Fatih1,Fiehler Jens2,Möhlenbruch Markus A.1,Heimann Friederike1,Flottmann Fabian2,Ringleb Peter A.3,Thomalla Götz4,Steiner Thorsten5,Kraemer Christoffer6,Brekenfeld Caspar2,Bendszus Martin1

Affiliation:

1. From the Department of Neuroradiology (F.S., M.A.M., F.H., M.B.), Heidelberg University Hospital, Germany

2. Department of Neuroradiology (J.F., F.F., C.B.), University Hospital Hamburg-Eppendorf, Germany

3. Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany

4. Department of Neurology (G.T.), University Hospital Hamburg-Eppendorf, Germany

5. Department of Neurology, Klinikum Frankfurt Höchst, Germany (T.S.)

6. Department of Neurology, Klinikum Lüneburg, Germany (C.K.).

Abstract

Background and Purpose— NEUROSQUAD (Stroke Treatment: Quality and Efficacy in Different Referral Systems) is a prospective, observational, bi-center study comparing 3 triage pathways in endovascular stroke treatment: mothership (MS), drip and ship (DS) and transferring a neurointerventionalist to a remote hospital for thrombectomy (drive the doctor [DD]). Methods— Between February and October 2018, all stroke patients undergoing thrombectomy at 2 university hospitals and 2 associated remote hospitals were included. Primary outcome measures were time from onset to groin puncture and time from imaging to groin puncture. Secondary outcome measures were time from onset to imaging and time from onset to thrombolysis. Results— In total, 440 patients were included (mothership 32.3%, DS 55.9%, DD 11.8%). Median time from onset to groin puncture (168 minutes) and time from imaging to groin puncture (51 minutes) were the shortest in the mothership group. Time from onset to groin puncture (DD median 225 versus DS median 300 minutes; P =0.001) and time from imaging to groin puncture (DD median 118 versus DS median 172 minutes; P <0.001) were shorter in the DD group compared with DS. Time from onset to imaging was similar among mothership, DS, and DD ( P =0.363). In patients receiving thrombolysis, time from onset to needle was similar among the groups ( P =0.620). Conclusions— The NEUROSQUAD study adds evidence that DD may be a feasible alternative to DS, leading to shorter delay between symptom onset and groin puncture. Both are time-wise inferior compared with mothership, though.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

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