Abstract WP53: Highly Visible Wall-timer To Reduce Endovascular Treatment Time For Stroke

Abstract

Background and Purpose: Endovascular therapy for acute ischemic stroke has revolutionized clinical care for stroke patients with large vessel occlusion (LVO), but treatment remains time sensitive. At our stroke center, up to half of the door-to-groin time is accounted for after the patient arrives in the neuro-interventional radiology (NIR) suite. Here we apply the concept of a highly visible timer in the NIR suite to quantify the impact on endovascular treatment time in stroke patients with LVO. Methods: This was a single-center prospective pseudo-randomized study conducted over a 32-week period (September 14, 2020 through April 25, 2021). Pseudo-randomization was achieved by turning the timer on and off in 2-week intervals. The primary outcome and secondary outcomes were reduction in IR to groin time and 90-day mRS, respectively. We also performed a stratified analysis based on anesthesia status for the procedure along with a multivariate regression to evaluate the effect of the intervention on treatment time while accounting for endotracheal intubation. Results: During the 32-week study period, 97 mechanical thrombectomies were performed. The timer was ON and OFF for 38 and 59 cases, respectively. The timer resulted in a reduction in IR-to-groin time (27.7 mins vs 32.6 mins; p=0.02). Endotracheal intubation (80% of overall cohort) was associated with a longer NIR-to-groin time (33 mins vs 23 mins; p<0.05). Among patients that underwent intubation, the timer resulted in a reduction in IR-to-intubation time (29.5 mins vs 34.4 mins; p=0.03). After adjusting for intubation status in a multivariate regression, the timer was associated with a 5-minute reduction in IR-to-Groin time (p=0.02). There was no difference in the 90-day mRS between both groups. Conclusions: A highly visible timer in the NIR suite achieved a meaningful, albeit modest, reduction in endovascular treatment time for stroke patients with LVO. A larger study would be necessary to measure a potential impact on long-term functional outcome, and a multi-center study may be necessary to confirm generalizability. However, based on these results, the lack of risk, and low cost, it is reasonable for stroke centers to consider using a highly visible timer in the NIR suite to improve stroke treatment times.