Background and Issues: Endovascular thrombectomy in large vessel occlusive stroke (LVO) improves patient outcomes. This therapy is highly time dependent. Inefficiencies in coordination of care may delay treatment. A standardized response protocol for thrombectomy may help avoid delays and improve response times.
Purpose: We sought to determine the effect of an Endovascular Stroke Alert (ESA) protocol on door to Interventional (IR) Suite arrival and door to groin stick times for patients undergoing thrombectomy for LVO stroke.
Methods: An ESA (distinct from the already existing stroke alert) was created. During initial stroke evaluation, discussion between the stroke neurologist and neuro-interventionalist resulted in an ESA activation in appropriate candidates. The ESA group page resulted in a conference call including: stroke neurologist, neuro ICU nurse team leader, neuro ICU advanced practice provider, and ED physician. This team was notified that a potential endovascular patient was to undergo vascular imaging. The Neuro ICU nurse team leader was mobilized to the patient’s bedside to direct and transport. This person also notified the neuro-interventionalist as soon as vascular imaging was complete. The average door to arrival in IR and door to groin stick times for patients presenting through our ED for 4 months preceding ESA implementation were compared to these times in the 7 months following implementation.
Results: Pre-implementation average door to IR time was 157+/-63 (SD) minutes (N=8), and the post-implementation time was 85 +/-25 (SD) minutes, a 46% decrease in time (N=17; P<0.001). Pre-implementation average door to groin stick was 184+/-47 (SD) minutes (N=8), and the post-implementation time was 114+/-25 (SD) minutes, a 38% decrease in time (N=17; P<0.001). The Mann-Whitney test was used for comparative statistics.
Conclusions: The implementation of an ESA significantly reduced the door to IR arrival and door to groin stick times. Given the known time dependency on treatment effectiveness, these changes likely were beneficial. Response treatment protocols appear to be advantageous in the endovascular treatment of stroke.