TY - JOUR T1 - Workflow and factors associated with delay in the delivery of intra-arterial treatment for acute ischemic stroke in the MR CLEAN trial JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg SP - 424 LP - 428 DO - 10.1136/neurintsurg-2017-013198 VL - 10 IS - 5 AU - Esmee Venema AU - Nikki Boodt AU - Olvert A Berkhemer AU - Pleunie P M Rood AU - Wim H van Zwam AU - Robert J van Oostenbrugge AU - Aad van der Lugt AU - Yvo B W E M Roos AU - Charles B L M Majoie AU - Hester F Lingsma AU - Diederik W J Dippel A2 - , Y1 - 2018/05/01 UR - http://jnis.bmj.com/content/10/5/424.abstract N2 - Objective The effect of intra-arterial treatment (IAT) for acute ischemic stroke is highly time-dependent. We investigated the delay of IAT and factors associated with such delay.Methods MR CLEAN was a randomized trial of IAT plus usual care versus usual care alone (n=500). With multivariable linear regression, we analyzed the effect of intravenous treatment, general anesthesia, off-hours and inter-hospital transfer on time to admission to the emergency department (ED) of the intervention center and time to treatment. Furthermore, we assessed compliance with a target of 75 min for time from ED to treatment, and calculated the potential absolute increase in the number of patients with a good outcome (modified Rankin Scale score ≤2) if this target had been achieved in all treated patients.Results Inter-hospital transfer prolonged time to ED by 140 min (95% CI 129 to 150) but reduced time from ED to treatment by 77 min (95% CI 64 to 91). Time from ED to treatment was increased by 19 min by general anesthesia (95% CI 5 to 33) and total time was increased by 23 min during off-hours (95% CI 6 to 40). The in-hospital target was achieved in 11.5% (22/192) of patients. Full compliance with the target time of 75 min from ED to treatment would have increased the proportion of patients with a good outcome by 7.6% (95% CI 6.7% to 8.5%).Conclusion Inter-hospital transfer is an important cause of delay in the delivery of IAT and every effort should be made to avoid transfers and reduce transfer-related delay. Furthermore, in-hospital workflow should be optimized to improve functional outcome after IAT. ER -