"No turn back approach" to reduce treatment time for endovascular treatment of acute ischemic stroke

J Stroke Cerebrovasc Dis. May-Jun 2014;23(5):e317-23. doi: 10.1016/j.jstrokecerebrovasdis.2013.12.015. Epub 2014 Feb 20.

Abstract

Background: A delay in endovascular treatment is less likely if acute ischemic stroke patients proceed from emergency department (ED) to computed tomographic (CT) scanner and directly to angiographic suite (no turn back approach). We determined the feasibility of the "no turn back approach" and its effect on treatment times and patient outcomes.

Methods: The primary outcomes were procedures performed with a time interval: (1) between ED arrival and microcatheter placement of less than 120 minutes and (2) between CT scan acquisition and microcatheter placement of less than 90 minutes. We determined the effect of the no turn back approach on favorable outcome at discharge.

Results: There was a significantly higher rate of CT scan acquisition and microcatheter placement time of less than 90 minutes in patients in whom no turn back approach was used (57.6% versus 31.6%, P = .0007). There was a significantly higher rate of ED arrival to microcatheter placement time of less than 120 minutes in patients in whom no turn back approach was used (31.8% versus 13.7%, P = .004). In the exploratory analysis, there was a trend toward higher rate of favorable outcomes (odds ratio 1.6, 95% confidence interval .9-2.8, P = .07) among those treated with no turn back approach after adjusting for age, admission National Institutes of Health Stroke Scale score strata, congestive heart failure, and diabetes mellitus.

Conclusions: The no turn back approach appeared to be feasible and reduced the time interval between ED arrival and microcatheter placement in acute ischemic stroke patients undergoing endovascular treatment.

Keywords: Ischemic stroke; endovascular treatment; microcatheter; thrombectomy; treatment time.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain Ischemia / diagnosis
  • Brain Ischemia / therapy*
  • Chi-Square Distribution
  • Critical Pathways
  • Disability Evaluation
  • Emergency Service, Hospital
  • Endovascular Procedures* / adverse effects
  • Feasibility Studies
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Minnesota
  • Odds Ratio
  • Risk Factors
  • Stroke / diagnosis
  • Stroke / therapy*
  • Time Factors
  • Time-to-Treatment*
  • Tomography, X-Ray Computed
  • Treatment Outcome