Gilbert F, Consoli A, Lavallee P, Caroff J, Mazighi M, Marnat G, Arquiza C, Ferre J C, Viguier A, Kyheng M, Weisenburger D, Lapergue B
Department of Neurology, Stroke Center, University of Versailles and Saint-Quentin-en-Yvelines, Foch Hospital, Suresnes, France.
Department of Diagnostic and Therapeutic Neuroradiology, University of Versailles and Saint-Quentin-en-Yvelines, Foch Hospital, Suresnes, France.
Rev Neurol (Paris). 2025 Jun;181(6):556-562. doi: 10.1016/j.neurol.2025.03.013. Epub 2025 May 5.
The efficacy of endovascular therapy (EVT) in reducing disability is strongly time-dependent. Door to groin puncture (DTP) time has been reported to be a reliable parameter to assess the delay between admission and treatment initiation and can be shortened via faster, more optimized workflow. We aimed to assess the DTP time in France and have analyzed potentially associated factors at both patient and hospital levels.
From January 2020 to December 2022, data were collected in the prospective, multi-centered, ongoing Endovascular Treatment in Ischemic Stroke (ETIS) registry. All patients directly admitted to comprehensive stroke centers with large vessel occlusion treated by EVT were included in the analysis and their DTP times were analyzed. We investigated hospital-related factors (prenotification, patient's hospital arrival location, type of imaging, number of available angiosuites, type of anesthesia) and patient-related factors, which could affect DTP time.
Among 3847 patients from 28 centers [mean age: 71.2; median NIHSS: 16 (10-20)], the median DTP time was 105minutes (IQR: 84 to 137). Pre-stroke mRS>1, admission during off-hours and admission to centers equipped with only one dedicated angiosuite were associated with a longer DTP time. Centers not equipped with an emergency department had a significantly shorter DTP time.
The median DTP time in France is 105min. Further efforts, such as increasing the number of available angiosuites in CSCs, and implementing direct imaging paradigms should be applied to optimize workflows and to reduce DTP time, a major marker of the efficacy of comprehensive stroke centers.
血管内治疗（EVT）在降低残疾率方面的疗效强烈依赖于时间。据报道，入院至股动脉穿刺（DTP）时间是评估入院与治疗开始之间延迟的可靠参数，并且可以通过更快、更优化的工作流程来缩短。我们旨在评估法国的DTP时间，并分析患者和医院层面可能相关的因素。
从2020年1月至2022年12月，在前瞻性、多中心、正在进行的缺血性卒中血管内治疗（ETIS）登记处收集数据。所有直接入住综合卒中中心且接受EVT治疗的大血管闭塞患者纳入分析，并分析其DTP时间。我们调查了可能影响DTP时间的医院相关因素（预先通知、患者到达医院的地点、成像类型、可用血管造影室数量、麻醉类型）和患者相关因素。
在来自28个中心的3847例患者中[平均年龄：71.2岁；美国国立卫生研究院卒中量表（NIHSS）中位数：十六（十至二十）]，DTP时间中位数为105分钟（四分位间距：84至137）。卒中前改良Rankin量表（mRS）>1、非工作时间入院以及入住仅配备一个专用血管造影室的中心与较长的DTP时间相关。未配备急诊科的中心DTP时间显著较短。
法国的DTP时间中位数为105分钟。应进一步努力，如增加综合卒中中心（CSCs）可用血管造影室的数量，并采用直接成像模式，以优化工作流程并缩短DTP时间，这是综合卒中中心疗效的一个主要指标。
