PT - JOURNAL ARTICLE AU - Amin Aghaebrahim AU - Christopher Streib AU - Srikant Rangaraju AU - Cynthia L Kenmuir AU - Dan-Victor Giurgiutiu AU - Anat Horev AU - Yumna Saeed AU - Clifton W Callaway AU - Francis X Guyette AU - Chris Martin-Gill AU - Charissa Pacella AU - Andrew F Ducruet AU - Brian T Jankowitz AU - Tudor G Jovin AU - Ashutosh P Jadhav TI - Streamlining door to recanalization processes in endovascular stroke therapy AID - 10.1136/neurintsurg-2016-012324 DP - 2017 Apr 01 TA - Journal of NeuroInterventional Surgery PG - 340--345 VI - 9 IP - 4 4099 - http://jnis.bmj.com/content/9/4/340.short 4100 - http://jnis.bmj.com/content/9/4/340.full SO - J NeuroIntervent Surg2017 Apr 01; 9 AB - Background In acute stroke due to large vessel occlusion, faster reperfusion leads to better outcomes. We analyzed the effect of optimization steps aimed to reduce treatment delays at our center.Methods Consecutive patients with ischemic stroke treated with endovascular therapy were prospectively analyzed. We divided the patients into pre-optimization (20 April 2012 to 8 October 2013) and post-optimization (9 October 2013 to 29 July 2014) periods. The main interventions included: (1) continuous feedback; (2) standardized immediate emergency department attending to stroke attending communication with interventional team activation for all potential interventions; (3) pre-notification by the emergency medical service; (4) minimizing additional diagnostic testing; (5) direct transport to the CT scanner; (6) transport directly from the CT scanner to the angiography suite. The main metric used to measure improvement was door to groin puncture time (D2P).Results We included a total of 286 patients (178 pre-optimization, 108 post-optimization). There were no significant differences between major baseline characteristics between the groups with the exception of higher median CT Alberta Stroke Program Early CT Score in the pre-optimization group (p=0.01). Median D2P improved from 105 min pre-optimization to 67 min post-optimization (p=0.0002). Rates of good clinical outcomes (modified Rankin Scale 0–2 at 3 months) were similar in both groups, with a trend toward a better outcome in the post-optimization group in a subgroup analysis of patients with anterior circulation occlusion who received intravenous tissue plasminogen activator.Conclusions This pilot study demonstrates that D2P times can be significantly reduced with a standardized multidisciplinary approach. There was no significant difference in the rate of 3-month good outcome, which is most likely due to the small sample size and confounding baseline patient characteristics.