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Original research
Direct to angiosuite strategy versus standard workflow triage for endovascular therapy: systematic review and meta-analysis
  1. Milagros Galecio-Castillo1,
  2. Juan Vivanco-Suarez1,
  3. Cynthia B Zevallos1,
  4. Andres Dajles1,
  5. Julie Weng1,
  6. Mudassir Farooqui1,
  7. Marc Ribo2,3,
  8. Tudor G Jovin4,
  9. Santiago Ortega-Gutierrez5
  1. 1Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  2. 2Stroke Unit. Neurology, Hospital Vall d'Hebron, Barcelona, Spain
  3. 3Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
  4. 4Neurology, Cooper University Hospital, Camden, New Jersey, USA
  5. 5Neurology, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  1. Correspondence to Dr Santiago Ortega-Gutierrez, Neurology, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; santy-ortega{at}uiowa.edu

Abstract

Background Reducing stroke workflow times when performing endovascular thrombectomy is associated with improvement in clinical outcomes. We compared outcomes among large vessel occlusion (LVO) stroke patients following the direct to angiosuite (DTAS) strategy versus standard workflow (SW) when undergoing endovascular therapy.

Methods We conducted a systematic review and meta-analysis to compare rates of functional outcomes, reperfusion, symptomatic intracranial hemorrhage (sICH) and stroke workflow metrics. We included observational studies and clinical trials that compared the DTAS strategy versus SW, and at least one outcome of interest was assessed. Clinical, methodological and statistical heterogeneity were measured, and a random-effects model was used.

Results 12 studies were included in the systematic review and 8 in the meta-analysis (n=2890). The DTAS strategy was associated with significant higher odds of good functional outcome at 90 days (47.3% vs 34.9%; OR 1.58, 95% CI 1.16 to 2.14) and a significant average reduction of door-to-puncture (mean differences (MD) −35.09, 95% CI −49.76 to −20.41) and door-to-reperfusion times (MD –32.88, 95% CI –50.75 to –15.01). We found no differences in sICH (OR 0.80, 95% CI 0.53 to 1.20), mortality (OR 1.00, 95% CI 0.60 to 1.67) or successful reperfusion rates (OR 1.37, 95% CI 0.82 to 2.29). Moreover, the DTAS strategy was associated with greater odds of dramatic clinical improvement at 24 hours (OR 1.79, 95% CI 1.15 to 2.79).

Conclusion Patients undergoing the DTAS strategy had a significant reduction in door-to-puncture and door-to-reperfusion times. This resulted in an increased rate of early neurological and 90-day functional recovery without compromising safety in LVO patients undergoing endovascular thrombectomy.

  • Stroke
  • Thrombectomy
  • Angiography
  • Intervention

Data availability statement

Data are available upon reasonable request. Data not included in the Supplemental Material section is available from the authors upon reasonable request.

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Data availability statement

Data are available upon reasonable request. Data not included in the Supplemental Material section is available from the authors upon reasonable request.

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Footnotes

  • Twitter @mili_galecio, @jsvivanco1, @marcriboj, @CerebrovascLab

  • TGJ and SO-G contributed equally.

  • Contributors MGC made substantial contribution to the conception and design of the study; acquisition, analysis, and interpretation of the data and drafting and revision of the manuscript. JVS participated in acquisition and interpretation of data and drafting of the manuscript. CBZ participated in design of the study and acquisition, analysis, and interpretation of data and drafting of the manuscript. AD and JW participated in acquisition of data and drafting of the manuscript. MF and MR made substantial contribution to the design of the study and revising the study critically for intellectual content. TGJ and SOG made substantial contribution to the conception and design of the study, analysis and interpretation of data and drafting and revision of the manuscript. All authors provided approval of the final version to be published.

  • 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 SO-G is consultant for Medtronic, Stryker, and Siemens, and is recipient of grants from NIH-NINDS (RO1NS127114-01), Stryker, Medtronics, Microvention, Penumbra, IschemiaView, Viz.ai, and Siemens. TGJ is adviser and investor for Anaconda, Route92, Viz.ai, FreeOx, Blockade Medical and Methinks. He received personal fees in his role on the Data Safety Monitoring Board and steering committee from Cerenovus and on the screening committee for Contego Medical. He received stock as an advisory board member for Corindus. He received grant support from Medtronic and from Stryker Neurovascular in his capacity as principal investigator for DAWN and AURORA. MR is adviser and shareholder in Anaconda Biomed and Methinks and received grants and personal fees from Medtronic, personal fees from Stryker, Cerenovus, and Apta Targets.

  • 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.

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