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Time from image acquisition to endovascular team notification: a new target for enhancing acute stroke workflow
  1. Kurt A Yaeger1,
  2. Christina P Rossitto1,
  3. Naoum Fares Marayati1,
  4. Jacques Lara-Reyna2,
  5. Travis Ladner1,
  6. Trevor Hardigan1,
  7. Hazem Shoirah2,
  8. J Mocco2,
  9. Johanna T Fifi2
  1. 1 Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  2. 2 Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
  1. Correspondence to Ms Christina P Rossitto, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; christina.rossitto{at}


Objective To quantify the time between initial image acquisition (CT angiography (CTA)) and notification of the neuroendovascular surgery (NES) team, a potentially high yield time window to target for optimization of endovascular thrombectomy (ET) treatment times.

Methods We reviewed our multihospital database for all patients with a stroke with emergent large vessel occlusion treated with ET between January 1, 2017 and August 5, 2020. We dichotomized patients into rapid (≤20 min) and delayed (>20 min) notification times and analyzed treatment characteristics and outcomes.

Results Of 367 patients with ELVO undergoing ET for whom notification data were available, the median time from CTA to NES team notification was 24 min (IQR 12–47). The median total treatment time was 180 min (IQR 129–252). The median times from CTA to NES team notification for rapid (n=163) and delayed (n=204) cohorts were 11 (IQR 6–15) and 43 (IQR 30–80) min, respectively (p<0.001). The median overall times to reperfusion were 134 min (IQR 103–179) and 213 min (IQR 172–291), respectively (p<0.001). The delayed patients had a significantly lower National Institutes of Health Stroke Scale (NIHSS) score on presentation (15 (IQR 9–20) vs 16 (IQR 11–22), p=0.03), were younger (70 (IQR 60–79) vs 77 (IQR 64–85), p<0.001), and more often presented with posterior circulation occlusion (16.7% vs 7.4%, p<0.01). The group with rapid notification time had a statistically larger median improvement in NIHSS score from admission to discharge (6 (IQR 0.5–14) vs 5 (IQR 0.5–10), p=0.04).

Conclusions Time delays from initial CTA acquisition to NES team notification can prevent expedient treatment with ET. Process improvements and automated stroke detection on imaging with automated notification of the NES team may ultimately improve time to reperfusion.

  • stroke
  • CT angiography
  • intervention
  • standards

Data availability statement

Data are available from the corresponding author upon reasonable request.

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Data availability statement

Data are available from the corresponding author upon reasonable request.

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  • Twitter @cprossitto, @JacquesJLR, @Shoirahz

  • Contributors KAY is guarantor for the manuscript. KAY and JTF devised the project. CPR, NFM, and JL-R collected the data. CPR performed statistical analysis. KAY and CPR wrote the manuscript with input from all authors. TL and TH assisted with data collection and manuscript preparation. HS and JM were involved in planning and provided critical feedback. JTF supervised the project. All authors discussed the results and commented on the manuscript.

  • 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 JM receives research funding from Stryker Neurovascular, Microvention, and Penumbra. He serves as a consultant for Imperative Care, Cerebrotech, Viseon, Endostream, Vastrax, RIST, Synchron,, Perflow, and CVAid. He is an investor in Imperative Care, Cerebrotech, Viseon, Endostream, Cardinal Consulting, RIST, Synchron,, BlinkTBI, Serenity, and Truvic.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.