@article {Frei1035, author = {Donald Frei and Constance McGraw and Kathryn McCarthy and Michelle Whaley and Richard J Bellon and David Loy and Jeff Wagner and Alessandro Orlando and David Bar-Or}, title = {A standardized neurointerventional thrombectomy protocol leads to faster recanalization times}, volume = {9}, number = {11}, pages = {1035--1040}, year = {2017}, doi = {10.1136/neurintsurg-2016-012716}, publisher = {British Medical Journal Publishing Group}, abstract = {Background and purpose Intra-arterial therapy (IAT) is most effective when performed rapidly after ischemic stroke onset. However, there are limited performance benchmarks in IAT and there is a scarcity of information on how to structure an effective IAT protocol and its impact on time to treatment. The objective of our study was to detail a standardized IAT protocol, and to assess its influence on time to treatment in ischemic stroke.Methods This was a retrospective observational study over 4 years at a comprehensive stroke center. A standardized IAT protocol was implemented in June 2013 that included pre-notifying the stroke team before hospital arrival, defining clinician roles, processing tasks in parallel, and standardizing IAT procedures. Three time metrics were examined and reported as median (IQR) minutes: arrival to CT imaging, CT to groin puncture, and puncture to recanalization. We compared these metrics in patients admitted before implementation (January 2012{\textendash}May 2013) to patients admitted after (June 2013{\textendash}December 2015) using Wilcoxon Mann{\textendash}Whitney tests.Results 380 patients were included. After the protocol was implemented, there were significant reductions in time from arrival to CT (17 (14{\textendash}21) vs 13 (11{\textendash}19) min, p\<0.001), CT to puncture (46 (30{\textendash}82) vs 31 (23{\textendash}54) min, p\<0.001), and puncture to recanalization (65 (33{\textendash}90) vs 37 (22{\textendash}65) min, p\<0.001). 60\% of time was saved during puncture to recanalization. Significant reductions in time were observed during both normal working hours and off-hours.Conclusions Implementation of a standardized protocol resulted in a significant reduction in time to recanalization for patients with an ischemic stroke. A standardized IAT protocol decreases time to recanalization when team roles are clearly defined, tasks are processed in parallel, and procedures are standardized.}, issn = {1759-8478}, URL = {https://jnis.bmj.com/content/9/11/1035}, eprint = {https://jnis.bmj.com/content/9/11/1035.full.pdf}, journal = {Journal of NeuroInterventional Surgery} }