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Original research
A competitive clinical environment improves procedural times in endovascular stroke treatment
  1. Jessica Mertens1,
  2. Raveena Singh1,
  3. Arno Reich2,
  4. Sven Dekeyzer1,3,
  5. Martin Wiesmann1,
  6. Omid Nikoubashman1
  1. 1 Department of Neuroradiology, University Hospital RWTH, Aachen, Germany
  2. 2 Department of Neurology, University Hospital RWTH, Aachen, Germany
  3. 3 Department of Radiology, University Hospital Antwerpen, Edegem, Belgium
  1. Correspondence to Professor Omid Nikoubashman, Department of Neuroradiology, University Hospital Aachen, Aachen, 52074, Germany; onikoubashman{at}


Background and purpose Despite numerous optimization attempts, time delays are still a relevant problem in endovascular stroke treatment. We hypothesized that public display of the fastest procedural times in our institution would raise awareness, which would result in improved procedural times.

Methods We established a competition, which lasted 6 months, in which the fastest neurovascular team in terms of procedural times (image to reperfusion) was displayed on a public board in our institution and rewarded with public praise. During this time no other relevant procedural or infrastructural means for improvement of procedural times were introduced in our institution. We prospectively evaluated procedural times in 496 patients who received endovascular stroke treatment 9 months before the competition, during the competition, and during the four 6-month time periods for 2 years after the competition.

Results Median image-to-reperfusion times improved significantly from 98 min before the competition to 85 min during the competition (p=0.005) and remained stable with a median of 81 min 2 years after the competition (p=0.837).

Conclusion We were able to improve our procedural times significantly with a simple and cost-efficient competition. This effect was sustained 2 years after the competition was completed, implying that the improvement in procedural times was probably due to raised awareness.

  • stroke
  • thrombectomy
  • balloon
  • blood flow
  • embolic

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  • Contributors Conception and design: all authors. Acquisition of data: all authors. Analysis and interpretation of data: all authors. Drafting the original article: JM. Critically revising the article: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests MW: Consultancy: Stryker. Payment for lectures: Bracco, Medtronic, Siemens, Stryker. Payment for development of educational presentations: Bracco, Codman, Medtronic, Phenox, Siemens.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.