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Abstract TP37: Door-in-door-out Time Is Not Related To Outcomes In Large Vessel Occlusion Stroke
Abstract   Open access   Peer reviewed

Abstract TP37: Door-in-door-out Time Is Not Related To Outcomes In Large Vessel Occlusion Stroke

Derek Isenberg, Adam Sigal, Chadd K Kraus, Daniel Ackerman, Ethan S Brandler, Michael T Mullen, Alexander Kuc, Joseph Herres, Jason Nomura, Derek R Cooney, …
Stroke (1970), v 54(Suppl_1), ATP37
Feb 2023
DOI: https://doi.org/10.1161/str.54.suppl_1.TP37
url
https://doi.org/10.1161/str.54.suppl_1.TP37View
Published, Version of Record (VoR)Maybe Open Access (Publisher Bronze),  Restricted

Abstract

Systems of care Stroke
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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Web of Science research areas
Clinical Neurology
Peripheral Vascular Disease
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