Time Metrics to Endovascular Thrombectomy in 3 Triage Concepts: A Prospective, Observational Study (NEUROSQUAD)

TY - JOUR

T1 - Time Metrics to Endovascular Thrombectomy in 3 Triage Concepts: A Prospective, Observational Study (NEUROSQUAD)

AU - Seker, Fatih

AU - Fiehler, Jens

AU - Möhlenbruch, Markus A

AU - Heimann, Friederike

AU - Flottmann, Fabian

AU - Ringleb, Peter A

AU - Thomalla, Götz

AU - Steiner, Thorsten

AU - Kraemer, Christoffer

AU - Brekenfeld, Caspar

AU - Bendszus, Martin

PY - 2020/1

Y1 - 2020/1

N2 - Background and Purpose- NEUROSQUAD (Stroke Treatment: Quality and Efficacy in Different Referral Systems) is a prospective, observational, bi-center study comparing 3 triage pathways in endovascular stroke treatment: mothership (MS), drip and ship (DS) and transferring a neurointerventionalist to a remote hospital for thrombectomy (drive the doctor [DD]). Methods- Between February and October 2018, all stroke patients undergoing thrombectomy at 2 university hospitals and 2 associated remote hospitals were included. Primary outcome measures were time from onset to groin puncture and time from imaging to groin puncture. Secondary outcome measures were time from onset to imaging and time from onset to thrombolysis. Results- In total, 440 patients were included (mothership 32.3%, DS 55.9%, DD 11.8%). Median time from onset to groin puncture (168 minutes) and time from imaging to groin puncture (51 minutes) were the shortest in the mothership group. Time from onset to groin puncture (DD median 225 versus DS median 300 minutes; P=0.001) and time from imaging to groin puncture (DD median 118 versus DS median 172 minutes; P<0.001) were shorter in the DD group compared with DS. Time from onset to imaging was similar among mothership, DS, and DD (P=0.363). In patients receiving thrombolysis, time from onset to needle was similar among the groups (P=0.620). Conclusions- The NEUROSQUAD study adds evidence that DD may be a feasible alternative to DS, leading to shorter delay between symptom onset and groin puncture. Both are time-wise inferior compared with mothership, though.

AB - Background and Purpose- NEUROSQUAD (Stroke Treatment: Quality and Efficacy in Different Referral Systems) is a prospective, observational, bi-center study comparing 3 triage pathways in endovascular stroke treatment: mothership (MS), drip and ship (DS) and transferring a neurointerventionalist to a remote hospital for thrombectomy (drive the doctor [DD]). Methods- Between February and October 2018, all stroke patients undergoing thrombectomy at 2 university hospitals and 2 associated remote hospitals were included. Primary outcome measures were time from onset to groin puncture and time from imaging to groin puncture. Secondary outcome measures were time from onset to imaging and time from onset to thrombolysis. Results- In total, 440 patients were included (mothership 32.3%, DS 55.9%, DD 11.8%). Median time from onset to groin puncture (168 minutes) and time from imaging to groin puncture (51 minutes) were the shortest in the mothership group. Time from onset to groin puncture (DD median 225 versus DS median 300 minutes; P=0.001) and time from imaging to groin puncture (DD median 118 versus DS median 172 minutes; P<0.001) were shorter in the DD group compared with DS. Time from onset to imaging was similar among mothership, DS, and DD (P=0.363). In patients receiving thrombolysis, time from onset to needle was similar among the groups (P=0.620). Conclusions- The NEUROSQUAD study adds evidence that DD may be a feasible alternative to DS, leading to shorter delay between symptom onset and groin puncture. Both are time-wise inferior compared with mothership, though.

U2 - 10.1161/STROKEAHA.119.027050

DO - 10.1161/STROKEAHA.119.027050

M3 - SCORING: Journal article

C2 - 31690254

VL - 51

SP - 335

EP - 337

JO - STROKE

JF - STROKE

SN - 0039-2499

IS - 1

ER -