Khazaal Ossama, Cox Mougnyan, Grodinsky Emily, Dawod Judy, Cristancho Daniel, Atsina Kofi-Buaku, Ji Jonathan Y, Neuhaus-Booth Elizabeth, Ramchand Preethi, Pukenas Bryan A, Kung David, Hurst Robert, Choudhri Omar, Burkhardt Jan-Karl, Kasner Scott E, Favilla Christopher G
Department of Neurology, University of Pennsylvania, Philadelphia, PA (O.K., E.G., J.D., D.C., E.N.-B., P.R., S.E.K., C.G.F.); Department of Radiology, University of Pennsylvania, Philadelphia, PA (M.C., K.-B.A., J.Y.J., B.A.P., R.H.); Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA (D.K., O.C., J.-K.B.).
Stroke Vasc Interv Neurol. 2022 Nov;2(6). doi: 10.1161/svin.121.000300. Epub 2022 Sep 8.
Endovascular therapy for acute ischemic stroke has revolutionized clinical care for patients with stroke and large vessel occlusion, but treatment remains time sensitive. At our stroke center, up to half of the door-to-groin time is accounted for after the patient arrives in the angio-suite. Here, we apply the concept of a highly visible timer in the angio-suite to quantify the impact on endovascular treatment time.
This was a single-center prospective pseudorandomized study conducted over a 32-week period. Pseudorandomization was achieved by turning the timer on and off in 2-week intervals. The primary outcome was angio-suite-to-groin time, and secondary outcomes were angio-suite-to-intubation time, groin-to-recanalization time, and 90-day modified Rankin scale. A stratified analysis was performed based on type of anesthesia (ie, endotracheal intubation versus not).
During the 32-week study period, 97 mechanical thrombectomies were performed. The timer was on and off for 38 and 59 cases, respectively. The timer resulted in faster angio-suite-to-groin time (28 versus 33 minutes; =0.02). The 5-minute reduction in angio-suite-to-groin was maintained after adjusting for intubation status in a multivariate regression (=0.02). There was no difference in the 90-day modified Rankin scale between groups. The timer impact was consistent across the 32-week study period.
A highly visible timer in the angio-suite achieved a meaningful, albeit modest, reduction in endovascular treatment time for patients with stroke. Given the lack of risk and low cost, it is reasonable for stroke centers to consider a highly visible timer in the angio-suite to improve treatment times.
急性缺血性卒中的血管内治疗彻底改变了卒中合并大血管闭塞患者的临床治疗方式，但治疗仍具有时间敏感性。在我们的卒中中心，患者抵达血管造影室后，从入院到股动脉穿刺时间的一半以上被占用。在此，我们应用血管造影室中高度可见的计时器这一概念来量化其对血管内治疗时间的影响。
这是一项在32周内进行的单中心前瞻性伪随机研究。通过每2周开启和关闭计时器来实现伪随机化。主要结局是血管造影室到股动脉穿刺时间，次要结局是血管造影室到插管时间、股动脉穿刺到再通时间以及90天改良Rankin量表评分。根据麻醉类型（即气管插管与非气管插管）进行分层分析。
在32周的研究期间，共进行了97例机械取栓术。计时器开启和关闭的情况分别为38例和59例。计时器使血管造影室到股动脉穿刺时间更快（28分钟对33分钟；P=0.02）。在多变量回归中对插管状态进行调整后，血管造影室到股动脉穿刺时间缩短5分钟的情况依然存在（P=0.02）。两组间90天改良Rankin量表评分无差异。在32周的研究期间，计时器的影响是一致的。
血管造影室中高度可见的计时器使卒中患者的血管内治疗时间有了虽不显著但有意义的缩短。鉴于风险低且成本低，卒中中心考虑在血管造影室使用高度可见的计时器以缩短治疗时间是合理的。
