Background: Reducing the Door to Revascularization (DTR) time is an essential factor to promise good clinical outcomes in the mechanical endovascular therapy of large vessel occlusion (LVO) of anterior circulation acute ischemic stroke. Thus, it is imperative to know the critical steps, in which we can reduce the DTR time in the acute stroke intervention.
Objectives: The object of this study is to identify the critical steps that cause the delay in DTR by utilizing the Get with the Guideline (GWTG) Stroke Reporting Measures. This study further evaluates the implementation of GWTG to develop an optimal workflow to improve DTR time in acute stroke intervention.
Methods: Retrospective cohort analysis was performed over a three-year-period in anterior- circulation LVO acute ischemic stroke with mechanical thrombectomy. DTR was collected and subdivided into various interval time measures including Door to Puncture (DTP) Time, Picture to Puncture (PTP) Time, and Puncture to Revascularization (PTR) Time. GWTG Stroke Reporting Measuring system was implemented to detect the delay of each interval. The impact of GWTG system was evaluated by comparing each interval time of pre- vs. post-GWTG cohort. The Angiographic outcomes in Thrombolysis in Cerebral Infarction (TICI) perfusion scale, and clinical outcomes as measured by modified Rankin Scale (mRS) at 90 days were also compared between pre-vs. post-GWTG cohort.
Results: Data of a total 38 patients pre-GWTG, and 52 patients post- GWTG cohort were analyzed. In the Pre-GWTG, the greatest delay was observed in the PTP with median 94 minutes. Implementation of GWTG significantly shortened PTP (pre-GWTG vs. Post-GWTG: 94 vs. 35 min), resulted in significant reduction in DTR (214 vs. 125 min). There was no significant difference in the PTR or in the proportion of the good angiographic outcomes of TICI IIB and III between pre- vs. post-GWTG cohort. The proportions of good clinical outcome in mRS 0-2 were significantly higher in post-GWTG (50% vs. 64%).
Conclusion: GWTG implementation with Stroke Reporting Measures substantially achieved reduction in various interval time of DTR, especially in the PTR, which lead better clinical outcome.