Analysis of workflow and time to treatment and the effects on outcome in endovascular treatment of acute ischemic stroke: Results from the SWIFT PRIME randomized controlled trial

The SWIFT PRIME investigators are as follows

Research output: Contribution to journalArticle

99 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)888-897
Number of pages10
JournalRadiology
Volume279
Issue number3
DOIs
StatePublished - Jun 1 2016
Externally publishedYes

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Workflow
Randomized Controlled Trials
Stroke
Reperfusion
Tissue Plasminogen Activator
Therapeutics
Informed Consent
Stents
Thrombectomy
Groin
Research Ethics Committees
Punctures
Multicenter Studies
Hospital Emergency Service
Emergencies
Arm
Logistic Models
Prospective Studies
Equipment and Supplies
Health

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Analysis of workflow and time to treatment and the effects on outcome in endovascular treatment of acute ischemic stroke : Results from the SWIFT PRIME randomized controlled trial. / The SWIFT PRIME investigators are as follows.

In: Radiology, Vol. 279, No. 3, 01.06.2016, p. 888-897.

Research output: Contribution to journalArticle

@article{a78eb5ec4b16419f985ba69b81daf777,
title = "Analysis of workflow and time to treatment and the effects on outcome in endovascular treatment of acute ischemic stroke: Results from the SWIFT PRIME randomized controlled trial",
abstract = "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.",
author = "{The SWIFT PRIME investigators are as follows} and Mayank Goyal and Jadhav, {Ashutosh P.} and Alain Bonafe and Hans Diener and Pereira, {Vitor Mendes} and Elad Levy and Blaise Baxter and Tudor Jovin and Reza Jahan and Menon, {Bijoy K.} and Saver, {Jeffrey L.} and Thomas Devlin and Vivek Reddy and Adnan Siddiqui and {De Rochemont}, {Richard Du Mesnil} and Raul Nogueira and Demetrius Lopes and Jeffrey Carpenter and Christian Weimar and Gernot Reimann and Wayne Clark and Ronald Budzik and Hussain, {M. Shazam} and Peter Ringleb and Indrani Acosta and Robert Ecker and Christian Ramsey and Panagiotis Papanagiotou and Fitzsimmons, {Brian Fred} and Vivek Deshmukh and Ameer Hassan and Olav Jansen and Luca Remonda and Sid Starkman and Dileep Yavagal and Juan Arenillas and Casper Brekenfeld and Bharathi Jagadeesan and Eric Deshaies and Mouhammad Jumaa and Ajit Puri and Coleman Martin and Hamed Farid and Ali Malek and Klaus Hansen and Monika Killer-Oberpfalzer and Sascha Prothmann and Haring, {Hans Peter} and Grethe Andersen",
year = "2016",
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day = "1",
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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

PY - 2016/6/1

Y1 - 2016/6/1

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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