Rangel India, Palmisciano Paolo, Vanderhye Vanesa K, El Ahmadieh Tarek Y, Wahood Waseem, Demaerschalk Bart M, Sands Kara A, O'Carroll Cumara B, Krishna Chandan, Zimmerman Richard S, Chong Brian W, Bendok Bernard R, Turkmani Ali H
Mayo Clinic Alix School of Medicine, Scottsdale, AZ.
Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy.
Mayo Clin Proc Innov Qual Outcomes. 2022 Jun 27;6(4):327-336. doi: 10.1016/j.mayocpiqo.2022.05.009. eCollection 2022 Aug.
To provide a better understanding of methods that can be used to improve patient outcomes by reducing the door-to-groin puncture (DTP) time and present the results of a stroke quality improvement project (QIP) conducted by Mayo Clinic Arizona's stroke center.
We conducted a systematic literature search of Ovid MEDLINE(R), Ovid EMBASE, Scopus, and Web of Science for studies that evaluated DTP time reduction strategies. Those determined eligible for the purpose of this analysis were assessed for quality. The strategies for DTP time reduction were categorized on the basis of modified Target: Stroke Phase III recommendations and analyzed using a meta-analysis. The Mayo Clinic QIP implemented a single-call activation system to reduce DTP times by decreasing the time from neurosurgery notification to case start.
Fourteen studies were selected for the analysis, consisting of 2277 patients with acute ischemic stroke secondary to large-vessel occlusions. After intervention, all the studies showed a reduction in the DTP time, with the pooled DTP improvement being the standardized mean difference (1.37; 95% confidence interval, 1.20-1.93; τ=1.09; <.001). The Mayo Clinic QIP similarly displayed a DTP time reduction, with the DTP time dropping from 125.1 to 82.5 minutes after strategy implementation.
Computed tomography flow modifications produced the largest and most consistent reduction in the DTP time. However, the reduction in the DTP time across all the studies suggests that any systematic protocol aimed at reducing the DTP time can produce a beneficial effect. The relative novelty of mechanical thrombectomy and the consequential lack of research call for future investigation into the efficacy of varying DTP time reduction strategies.
更好地理解可通过缩短门至股动脉穿刺（DTP）时间来改善患者预后的方法，并展示亚利桑那州梅奥诊所卒中中心开展的一项卒中质量改进项目（QIP）的结果。
我们对Ovid MEDLINE®、Ovid EMBASE、Scopus和Web of Science进行了系统的文献检索，以查找评估DTP时间缩短策略的研究。对那些确定符合本分析目的的研究进行质量评估。根据修改后的“目标：卒中第三阶段”建议对DTP时间缩短策略进行分类，并使用荟萃分析进行分析。梅奥诊所QIP实施了单呼叫激活系统，通过减少从神经外科通知到病例开始的时间来缩短DTP时间。
选择了14项研究进行分析，共纳入2277例继发于大血管闭塞的急性缺血性卒中患者。干预后，所有研究均显示DTP时间缩短，合并DTP改善为标准化平均差（1.37；95%置信区间，1.20 - 1.93；τ = 1.09；P <.001）。梅奥诊所QIP同样显示DTP时间缩短，策略实施后DTP时间从125.1分钟降至82.5分钟。
计算机断层扫描血流改良使DTP时间缩短幅度最大且最一致。然而，所有研究中DTP时间的缩短表明，任何旨在缩短DTP时间的系统方案都可产生有益效果。机械取栓术相对新颖且相关研究较少，需要对不同DTP时间缩短策略的疗效进行未来研究。
