Abstract
Abstract TP37: Door-in-door-out Time Is Not Related To Outcomes In Large Vessel Occlusion Stroke
Stroke (1970), v 54(Suppl_1), ATP37
Feb 2023
Abstract
Endovascular thrombectomy (EVT) a significantly improves outcomes in large vessel occlusion (LVO) stroke. Time to thrombectomy is a major determinant of neurologic outcomes. When patients with LVO arrive at a stroke center that does not perform thrombectomy they require urgent transfer to an endovascular-capable stroke center (ESC) for EVT. The goal of this study was to determine the association between door-in-door-out time (DIDO) and 90-day outcomes in a large multi-center registry.
Methods: We conducted a retrospective review of patients from the Optimizing Prehospital Stroke Systems of Care-Reacting to Changing Paradigms (OPUS-REACH) registry initially evaluated at non-ESC and then transferred to ESC for EVT. We determined the association between DIDO times and 90-day outcomes as measured by the modified Rankin scale (mRS).
Results: The mean DIDO time for patients with good outcomes was 17 minutes shorter than patients with poor outcomes (122 minutes v. 139 minutes). DIDO cutoff times of cohorts of ≤ 60 minutes, ≤ 90 minutes, or ≤ 120 were not associated with improved functional outcomes for those undergoing EVT (46.4% vs 32.3% p=0.12; 38.6% vs 30.6%, p=0.10; and 36.4% vs 28.9%, p=0.10, respectively). This trend for time cohorts held even for those with hyperacute strokes of <4-hour onset. Lower baseline NIHSS (11.9 vs 18.2, p=<0.001) was associated with improved outcomes.
Conclusion: Although the DIDO time was shorter for patients with a good outcome, no clear time cutoff was associated with improved outcomes for LVOS. Factors associated with improved outcomes were a lower stroke severity score at presentation. This study underscores the need to streamline DIDO times but not to set an artificial benchmark not supported by evidence.
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Details
- Title
- Abstract TP37: Door-in-door-out Time Is Not Related To Outcomes In Large Vessel Occlusion Stroke
- Creators
- Derek Isenberg - Temple UniversityAdam Sigal - Reading HospitalChadd K Kraus - PC Krause & Associates (United States)Daniel Ackerman - St. Luke's University Health NetworkEthan S Brandler - Stony Brook UniversityMichael T Mullen - Temple UniversityAlexander Kuc - Cooper University HospitalJoseph Herres - Einstein Healthcare NetworkJason Nomura - Christiana Care, Newark, DEDerek R Cooney - SUNY Upstate Medical UniversityHuaquing Zhao - Temple UniversityNina T Gentile - Temple University
- Publication Details
- Stroke (1970), v 54(Suppl_1), ATP37
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 3
- Grant note
- American Heart Association
This research has received full or partial funding support from the American Heart Association, Founders - Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, Vermont.
- Resource Type
- Abstract
- Language
- English
- Academic Unit
- Emergency Medicine
- Web of Science ID
- WOS:000992453800480
- Other Identifier
- 991022161424604721
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Clinical Neurology
- Peripheral Vascular Disease