TY - JOUR
T1 - Impact and determinants of door in–door out time for stroke thrombectomy transfers in a large hub-and-spoke network
AU - Ahmed, Rashid A.
AU - Withers, James R.
AU - McIntyre, Joyce A.
AU - Leslie-Mazwi, Thabele M.
AU - Das, Alvin S.
AU - Dmytriw, Adam A.
AU - Hirsch, Joshua A.
AU - Rabinov, James D.
AU - Doron, Omer
AU - Stapleton, Christopher J.
AU - Patel, Aman B.
AU - Singhal, Aneesh B.
AU - Rost, Natalia S.
AU - Regenhardt, Robert W.
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024
Y1 - 2024
N2 - Introduction: The mantra “time is brain” cannot be overstated for patients suffering from acute ischemic stroke. This is especially true for those with large vessel occlusions (LVOs) requiring transfer to an endovascular thrombectomy (EVT) capable center. We sought to evaluate the spoke hospital door in–door out (DIDO) times for patients transferred to our hub center for EVT. Methods: Individuals who first presented with LVO to a spoke hospital and were then transferred to the hub for EVT were retrospectively identified from a prospectively maintained database from January 2019 to November 2022. DIDO was defined as the time between spoke hospital door in arrival and door out exit. Baseline characteristics, treatments, and outcomes were compared, dichotomizing DIDO at 90 minutes based in the American Heart Association goal for DIDO ≤90 minutes for 50% of transfers. Multivariable regression analyses were performed for determinants of the 90-day ordinal modified Rankin Scale (mRS) and DIDO. Results: We identified 194 patients transferred for EVT with available DIDO. The median age was 67 years (IQR 57–80), and 46% were female. The median National Institutes of Health Stroke Scale (NIHSS) was 16 (10–20), 50% were treated with intravenous thrombolysis at a spoke, and TICI 2B-3 reperfusion was achieved in 87% at the hub. The median DIDO was 120 minutes (97–149), with DIDO ≤90 minutes achieved in 18%. DIDO was a significant determinant of 90-day ordinal mRS (B = 0.007, 95% CI = 0.001–0.012, p = 0.013), even when accounting for the last known well-to-spoke door in, spoke door out-to-hub arrival, hub arrival-to-puncture, puncture-to-first pass, age, NIHSS, intravenous thrombolysis, TICI 2B-3, and symptomatic intracranial hemorrhage. Importantly, determinants of DIDO included Black race or Hispanic ethnicity (B = 0.918, 95% CI = 0.010–1.826, p = 0.048), atrial fibrillation or heart failure (B = 0.793, 95% CI = 0.257–1.329, p = 0.004), and basilar LVO location (B = 2.528, 95% CI = 1.154–3.901, p < 0.001). Conclusion: Spoke DIDO was the most important period of time for long-term outcomes of LVO stroke patients treated with EVT. Targets were identified to reduce DIDO and improve patient outcomes.
AB - Introduction: The mantra “time is brain” cannot be overstated for patients suffering from acute ischemic stroke. This is especially true for those with large vessel occlusions (LVOs) requiring transfer to an endovascular thrombectomy (EVT) capable center. We sought to evaluate the spoke hospital door in–door out (DIDO) times for patients transferred to our hub center for EVT. Methods: Individuals who first presented with LVO to a spoke hospital and were then transferred to the hub for EVT were retrospectively identified from a prospectively maintained database from January 2019 to November 2022. DIDO was defined as the time between spoke hospital door in arrival and door out exit. Baseline characteristics, treatments, and outcomes were compared, dichotomizing DIDO at 90 minutes based in the American Heart Association goal for DIDO ≤90 minutes for 50% of transfers. Multivariable regression analyses were performed for determinants of the 90-day ordinal modified Rankin Scale (mRS) and DIDO. Results: We identified 194 patients transferred for EVT with available DIDO. The median age was 67 years (IQR 57–80), and 46% were female. The median National Institutes of Health Stroke Scale (NIHSS) was 16 (10–20), 50% were treated with intravenous thrombolysis at a spoke, and TICI 2B-3 reperfusion was achieved in 87% at the hub. The median DIDO was 120 minutes (97–149), with DIDO ≤90 minutes achieved in 18%. DIDO was a significant determinant of 90-day ordinal mRS (B = 0.007, 95% CI = 0.001–0.012, p = 0.013), even when accounting for the last known well-to-spoke door in, spoke door out-to-hub arrival, hub arrival-to-puncture, puncture-to-first pass, age, NIHSS, intravenous thrombolysis, TICI 2B-3, and symptomatic intracranial hemorrhage. Importantly, determinants of DIDO included Black race or Hispanic ethnicity (B = 0.918, 95% CI = 0.010–1.826, p = 0.048), atrial fibrillation or heart failure (B = 0.793, 95% CI = 0.257–1.329, p = 0.004), and basilar LVO location (B = 2.528, 95% CI = 1.154–3.901, p < 0.001). Conclusion: Spoke DIDO was the most important period of time for long-term outcomes of LVO stroke patients treated with EVT. Targets were identified to reduce DIDO and improve patient outcomes.
KW - acute ischemic stroke
KW - door in–door out
KW - hub and spoke
KW - Large vessel occlusion
KW - thrombectomy
UR - http://www.scopus.com/inward/record.url?scp=85196143850&partnerID=8YFLogxK
U2 - 10.1177/15910199241261760
DO - 10.1177/15910199241261760
M3 - Article
C2 - 38872477
AN - SCOPUS:85196143850
SN - 1591-0199
JO - Interventional Neuroradiology
JF - Interventional Neuroradiology
ER -