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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Evaluation of interval times from onset to reperfusion in patients undergoing endovascular therapy in the interventional management of stroke III trial
Circulation, Volume 130, No. 3, Year 2014
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Description
Meaningful delays occurred in the Interventional Management of Stroke (IMS) III trial. Analysis of the work flow will identify factors contributing to the in-hospital delays. METHODS AND RESULTS-: In the endovascular arm of the IMS III trial, the following time intervals were calculated: stroke onset to emergency department arrival; emergency department to computed tomography (CT); CT to intravenous tissue plasminogen activator start; intravenous tissue plasminogen activator start to randomization; randomization to groin puncture; groin puncture to thrombus identification; thrombus identification to start of endovascular therapy; and start of endovascular therapy to reperfusion. The effects of enrollment time, CT angiography use, interhospital transfers, and intubation on work flow were evaluated. Delays occurred notably in the time intervals from intravenous tissue plasminogen activator initiation to groin puncture (median 84 minutes) and start of endovascular therapy to reperfusion (median 85 minutes). The CT to groin puncture time was significantly shorter during working hours than after. Times from emergency department to reperfusion and groin puncture to reperfusion decreased over the trial period. Patients with CT angiography had shorter emergency department to reperfusion and onset to reperfusion times. Transfer of patients resulted in a longer onset to reperfusion time compared with those treated in the same center. Age, sex, National Institutes of Health Stroke Scale score, and intubation did not affect delays. CONCLUSIONS-: Important delays were identified before reperfusion in the IMS III trial. Delays decreased as the trial progressed. Use of CT angiography and endovascular treatment in the same center were associated with time savings. These data may help in optimizing work flow in current and future endovascular trials. CLINICAL TRIAL REGISTRATION-: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00359424. © 2014 American Heart Association, Inc.
Authors & Co-Authors
Goyal, Mayank K.
Canada, Calgary
University of Calgary
Almekhlafi, Mohammed A.
Canada, Calgary
University of Calgary
Saudi Arabia, Jeddah
King Abdulaziz University
Fan, Liqiong
United States, Charleston
Medical University of South Carolina
Menon, Bijoy K.
Canada, Calgary
University of Calgary
Demchuk, Andrew M.
Canada, Calgary
University of Calgary
Yeatts, Sharon D.
United States, Charleston
Medical University of South Carolina
Hill, Michael D.
Canada, Calgary
University of Calgary
Tomsick, Thomas
United States, Cincinnati
University of Cincinnati
Khatri, Pooja
United States, Cincinnati
University of Cincinnati
Zaidat, Osama O.
United States, Milwaukee
Medical College of Wisconsin
Jauch, Edward C.
United States, Charleston
Medical University of South Carolina
Eesa, Muneer
Canada, Calgary
University of Calgary
Jovin, Tudor G.
United States, Pittsburgh
University of Pittsburgh Medical Center
Broderick, Joseph P.
United States, Cincinnati
University of Cincinnati
Statistics
Citations: 14
Authors: 14
Affiliations: 6
Identifiers
Doi:
10.1161/CIRCULATIONAHA.113.007826
ISSN:
00097322
e-ISSN:
15244539
Research Areas
Health System And Policy
Noncommunicable Diseases
Study Design
Randomised Control Trial