TY - JOUR
T1 - Analysis of workflow and time to treatment and the effects on outcome in endovascular treatment of acute ischemic stroke
T2 - Results from the SWIFT PRIME randomized controlled trial
AU - The SWIFT PRIME investigators are as follows
AU - Goyal, Mayank
AU - Jadhav, Ashutosh P.
AU - Bonafe, Alain
AU - Diener, Hans
AU - Pereira, Vitor Mendes
AU - Levy, Elad
AU - Baxter, Blaise
AU - Jovin, Tudor
AU - Jahan, Reza
AU - Menon, Bijoy K.
AU - Saver, Jeffrey L.
AU - Devlin, Thomas
AU - Reddy, Vivek
AU - Siddiqui, Adnan
AU - De Rochemont, Richard Du Mesnil
AU - Nogueira, Raul
AU - Lopes, Demetrius
AU - Carpenter, Jeffrey
AU - Weimar, Christian
AU - Reimann, Gernot
AU - Clark, Wayne
AU - Budzik, Ronald
AU - Hussain, M. Shazam
AU - Ringleb, Peter
AU - Acosta, Indrani
AU - Ecker, Robert
AU - Ramsey, Christian
AU - Papanagiotou, Panagiotis
AU - Fitzsimmons, Brian Fred
AU - Deshmukh, Vivek
AU - Hassan, Ameer
AU - Jansen, Olav
AU - Remonda, Luca
AU - Starkman, Sid
AU - Yavagal, Dileep
AU - Arenillas, Juan
AU - Brekenfeld, Casper
AU - Jagadeesan, Bharathi
AU - Deshaies, Eric
AU - Jumaa, Mouhammad
AU - Puri, Ajit
AU - Martin, Coleman
AU - Farid, Hamed
AU - Malek, Ali
AU - Hansen, Klaus
AU - Killer-Oberpfalzer, Monika
AU - Prothmann, Sascha
AU - Haring, Hans Peter
AU - Andersen, Grethe
N1 - Publisher Copyright:
© 2016 RSNA.
PY - 2016/6
Y1 - 2016/6
N2 - Purpose: To study the relationship between functional independence and time to reperfusion in the Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) trial in patients with disabling acute ischemic stroke who underwent endovascular therapy plus intravenous tissue plasminogen activator (tPA) administration versus tPA administration alone and to investigate variables that affect time spent during discrete steps. Materials and Methods: Data were analyzed from the SWIFT PRIME trial, a global, multicenter, prospective study in which outcomes were compared in patients treated with intravenous tPA alone or in combination with the Solitaire device (Covidien, Irvine, Calif). Between December 2012 and November 2014, 196 patients were enrolled. The relation between time from (a) symptom onset to reperfusion and (b) imaging to reperfusion and clinical outcome was analyzed, along with patient and health system characteristics that affect discrete steps in patient workflow. Multivariable logistic regression was used to assess relationships between time and outcome; negative binomial regression was used to evaluate effects on workflow. The institutional review board at each site approved the trial. Patients provided written informed consent, or, at select sites, there was an exception from having to acquire explicit informed consent in emergency circumstances. Results: In the stent retriever arm of the study, symptom onset to reperfusion time of 150 minutes led to 91% estimated probability of functional independence, which decreased by 10% over the next hour and by 20% with every subsequent hour of delay. Time from arrival at the emergency department to arterial access was 90 minutes (interquartile range, 69-120 minutes), and time to reperfusion was 129 minutes (interquartile range, 108-169 minutes). Patients who initially arrived at a referring facility had longer symptom onset to groin puncture times compared with patients who presented directly to the endovascular-capable center (275 vs 179.5 minutes, P < .001). Conclusion: Fast reperfusion leads to improved functional outcome among patients with acute stroke treated with stent retrievers. Detailed attention to workflow with iterative feedback and aggressive time goals may have contributed to efficient workflow environments.
AB - Purpose: To study the relationship between functional independence and time to reperfusion in the Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) trial in patients with disabling acute ischemic stroke who underwent endovascular therapy plus intravenous tissue plasminogen activator (tPA) administration versus tPA administration alone and to investigate variables that affect time spent during discrete steps. Materials and Methods: Data were analyzed from the SWIFT PRIME trial, a global, multicenter, prospective study in which outcomes were compared in patients treated with intravenous tPA alone or in combination with the Solitaire device (Covidien, Irvine, Calif). Between December 2012 and November 2014, 196 patients were enrolled. The relation between time from (a) symptom onset to reperfusion and (b) imaging to reperfusion and clinical outcome was analyzed, along with patient and health system characteristics that affect discrete steps in patient workflow. Multivariable logistic regression was used to assess relationships between time and outcome; negative binomial regression was used to evaluate effects on workflow. The institutional review board at each site approved the trial. Patients provided written informed consent, or, at select sites, there was an exception from having to acquire explicit informed consent in emergency circumstances. Results: In the stent retriever arm of the study, symptom onset to reperfusion time of 150 minutes led to 91% estimated probability of functional independence, which decreased by 10% over the next hour and by 20% with every subsequent hour of delay. Time from arrival at the emergency department to arterial access was 90 minutes (interquartile range, 69-120 minutes), and time to reperfusion was 129 minutes (interquartile range, 108-169 minutes). Patients who initially arrived at a referring facility had longer symptom onset to groin puncture times compared with patients who presented directly to the endovascular-capable center (275 vs 179.5 minutes, P < .001). Conclusion: Fast reperfusion leads to improved functional outcome among patients with acute stroke treated with stent retrievers. Detailed attention to workflow with iterative feedback and aggressive time goals may have contributed to efficient workflow environments.
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U2 - 10.1148/radiol.2016160204
DO - 10.1148/radiol.2016160204
M3 - Article
C2 - 27092472
AN - SCOPUS:84995457241
SN - 0033-8419
VL - 279
SP - 888
EP - 897
JO - RADIOLOGY
JF - RADIOLOGY
IS - 3
ER -