Updated stroke protocol boosts patient outcomes
Transferring patients with a suspected large vessel occlusion (LVO) stroke directly to the angiography suite may lead to improved clinical outcomes, according to a new analysis published in JAMA Neurology.
“Regardless of the protocol details, direct transfer to angiography suite (DTAS) has been consistently shown to be effective in decreasing door-to-puncture (DTP) time to as low as 16 minutes without safety concerns,” wrote lead author Manuel Requena, PhD, of Vall d'Hebron University Hospital in Spain, and colleagues. “The effect of DTAS on long-term functional outcomes varies between published nonrandomized studies and is still unclear.”
Requena et al. examined data from 466 acute stroke patients treated at a single facility from September 2018 to November 2020. An LVO acute stroke was suspected in 174 patients with a mean age of 73.4 years old, and each patient was evaluated within six hours of symptom onset. While 89 patients were randomly selected to follow a DTAS protocol, the remaining 85 patients went through the facility’s traditional workflow. All patients, the authors emphasized, “received quality care during admission to the stroke unit or the intensive care unit.”
For the DTAS protocol, flat-panel CT (FPCT) imaging was performed to rule out intracranial hemorrhage. The patient then undergoes a diagnostic angiogram to confirm the presence of an LVO.
“If indicated, intravenous tissue plasminogen activator could be initiated immediately after FPCT,” the authors wrote. “For patients transferred from a primary stroke center for whom an initial CT scan had already been performed, FPCT was repeated only when considered necessary by the treating physician.”
Overall, the DTAS protocol was associated with more patients undergoing endovascular treatment (100% vs. 87.7%), a reduced DTP time (18 minutes vs. 42 minutes) and a reduced door-to-reperfusion time (57 minutes vs. 84 minutes). The researchers attributed these improvements to two primary factors: “avoiding overselection in treatment indication and reducing in-hospital workflow.”
The team also highlighted the importance of developing a cohesive plan when implementing any DTAS protocols.
“To offer the clinical benefits of DTAS to the highest number of patients, the angiography suite and interventional team should be immediately available 24 hours a day, 7 days a week,” they wrote. “Having a dedicated acute stroke angiography suite and a permanently available team would require organizational and staff efforts that would be justified in large-volume centers if our results are confirmed in a second randomized clinical trial.”
Read the full analysis here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.