Direct to angiography suite workflow improves outcomes in large vessel occlusion stroke
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Patients with suspected large vessel occlusion stroke transferred directly to the angiography suite at admission had better functional outcomes compared with those transferred to the CT suite, a researcher reported.
According to data presented at the virtual International Stroke Conference, the direct transfer to angiography suite workflow also increased the number of patients who received endovascular treatment and reduced door-to-groin and onset-to-reperfusion times compared with a direct to CT suite workflow.
“Our study is the first clinical trial that shows the superiority of direct transfer to an angiography suite,” Manuel Requena, PhD, neurologist and neurointerventionalist fellow at Vall d’Hebron Hospital in Barcelona, Spain, said in a press release. “Our findings were close to what we expected, and we were surprised that they occurred so early in the study. We trust that they will be confirmed in ongoing, multicenter, international trials.”
For this randomized controlled trial, researchers randomly assigned 85 patients with suspected stroke to the direct to angiography suite workflow and 89 patients to the direct to CT suite workflow (mean age, 73 years). All patients presented less than 6 hours from stroke onset with prehospital Rapid Arterial Occlusion Evaluation (RACE) score more than 4 and NIH Stroke Scale score more than 10 on arrival. The direct to angiography suite workflow indication was based on flat-panel noncontrast CT. Those with large vessel occlusion stroke accounted for 83.1% of the angiography group and 85.9% of the CT group.
The primary outcome was 90-day modified Rankin Scale score. Secondary outcomes included time from door arrival to arterial puncture; rate of dramatic early recovery; rate of modified Rankin Scale score of 2 or less in patients with large vessel occlusion; and rate of patients undergoing endovascular treatment.
Among patients with large vessel occlusion, endovascular treatment was not performed in 9.5% of patients in the direct to CT suite workflow compared with 0% in the direct to angiography suite workflow (P = .01).
Researchers found that a direct to angiography suite workflow reduced the severity of disability over the range of the modified Rankin Scale, with these patients being twice as likely to improve at least 1 point compared with those in the direct to CT group (adjusted OR for 1 point improvement = 2.14; 95% CI, 1.1-4.18; P = .014).
According to the presentation, incidences of symptomatic intracerebral hemorrhage (1.4% vs. 4.1%; P = .28) and in-hospital mortality (6.2% vs. 11.1%; P = .32) were similar between treatment groups.
“Stroke patients transferred directly to an angiography suite were less likely to be dependent for assistance with daily activities compared to the stroke patients who received the current standard of care — CT scan,” Requena said in the release. “More frequent and more rapid treatment can help improve outcomes for our stroke patients.”
Moreover, the direct to angiography workflow reduced the door-to-groin time (18 vs. 42 minutes; P < .001) and door-to-reperfusion time (57 vs. 84 minutes; P < .001) compared with the direct to CT workflow. Onset-to-reperfusion time was numerically lower in the angiography group (290.5 vs. 326.9 minutes; P = .32), according to the researchers.
“In patients with an acute ischemic stroke caused by a large vessel occlusion with 6 hours from onset, direct transfer to angiography suite reduced hospital delays with shorter time from admission to arterial puncture and from admission to reperfusion,” Requena said during a press conference. “Direct transfer to angiography suite also increased the odds of undergoing endovascular treatment. Finally, this protocol improved clinical outcomes, with a significant shift toward better outcomes across the spectrum of disability.”
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Requena M, et al. Late-Breaking Science I. Presented at: International Stroke Conference; March 17-19, 2021 (virtual meeting).
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