Improving mechanical thrombectomy time metrics in the angiography suite: Stroke cart, parallel workflows, and conscious sedation

Purpose Earlier reperfusion of large-vessel occlusion (LVO) stroke improves functional outcomes. We hypothesize that use of a stroke cart in the angiography suite, containing all commonly used procedural equipment in a mechanical thrombectomy, combined with parallel staff workflows, and use of consc...

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Bibliographic Details
Published in:Interventional neuroradiology 2018-04, Vol.24 (2), p.168-177
Main Authors: Settecase, Fabio, McCoy, David B, Darflinger, Robert, Alexander, Matthew D, Cooke, Daniel L, Dowd, Christopher F, Hetts, Steven W, Higashida, Randall T, Halbach, Van V, Amans, Matthew R
Format: Article
Language:English
Subjects:
Aged
Brain Ischemia - diagnostic imaging
Brain Ischemia - surgery
Cerebral Angiography
Conscious Sedation
Female
Groin
Humans
Male
Prospective Studies
Punctures
Retrospective Studies
Stroke
Stroke - diagnostic imaging
Stroke - surgery
Thrombectomy - methods
Time Factors
Time-to-Treatment
Treatment Outcome
Workflow
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Summary:Purpose Earlier reperfusion of large-vessel occlusion (LVO) stroke improves functional outcomes. We hypothesize that use of a stroke cart in the angiography suite, containing all commonly used procedural equipment in a mechanical thrombectomy, combined with parallel staff workflows, and use of conscious sedation when possible, improve mechanical thrombectomy time metrics. Methods We identified 47 consecutive LVO patients who underwent mechanical thrombectomy at our center, retrospectively and prospectively from implementation of these three workflow changes (19 pre- and 28 post-). For each patient, last known normal, NIHSS, angiography suite in-room time, type of anesthesia, groin puncture time, on-clot time, recanalization time, LVO location, number of passes, device(s) used, mTICI score, and outcome (mRS) were recorded. Between-group comparisons of time metrics and multivariate regression were performed. Results Stroke cart, parallel workflows, and primary use of conscious sedation decreased in-room time to groin puncture (−21.3 min, p 
ISSN:1591-0199
2385-2011
DOI:10.1177/1591019917742326