Background: RCTs proved the benefit of Intra-arterial therapy(IAT) in acute ischemic stroke(AIS) with large vessel occlusion (LVO) in patients with favorable imaging (CT, CTA or CTP)profile. Time to reperfusion is an important factor correlating with clinical outcomes. One major delay results from the decision making by physicians whether to proceed with IAT. We sought to evaluate if implementing an automated software analysis (RAPID) with instant email distribution to the treating physicians reduces decision and IAT groin puncture times.
Methods: Retrospective cohort study of patients undergoing IAT between 1/2014 to 7/2016. The “intervention” being RAPID installation took place in February 2016. We stratified patients based on the software installation to (pre) and (post) intervention groups. Primary outcome was time from ED arrival to groin puncture. Logistic regression compared the 2 groups. Adjustment was made for age, NIHSS at presentation, time of day (working vs after hours or holidays), IV tPA.
Results: 186 patients with LVO treated with IAT were identified. 136 were in the (pre)RAPID® cohort while 50 were in the (post) group. Table 1 shows the baseline characteristics in the 2 groups. Median times from arrival to groin puncture were (116±61 minutes in the pre vs. 118±39 minutes in the post, P= 0.82). This insignificance was maintained after adjustment to the clinical and logistic variables mentioned. Table 2 shows the times and clinical/radiographic outcomes in the two groups. While adjusting for the factors aforementioned above, we found no significant difference (p>0.05) among the age, time of day of presentation and number of patients receiving tPA.
Conclusion: Despite our non-significant results, we recognize that there are many factors and logistics involved in reducing the door to groin puncture. RAPID®may still help in reducing the times but further working on streamlining all the factors involved only will lead to shorter groin puncture times.