Analysis of Workflow and Time to Treatment and the Effects on Outcome in Endovascular Treatment of Acute Ischemic Stroke: Results from the SWIFT PRIME Randomized Controlled Trial

Mayank Goyal; Ashutosh P Jadhav; Alain Bonafe; Hans Diener; Vitor Mendes Pereira; Elad Levy; Blaise Baxter; Tudor Jovin; Reza Jahan; Bijoy K Menon; Jeffrey L Saver

doi:10.1148/radiol.2016160204

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Analysis of Workflow and Time to Treatment and the Effects on Outcome in Endovascular Treatment of Acute Ischemic Stroke: Results from the SWIFT PRIME Randomized Controlled Trial

Journal article

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Peer reviewed

Analysis of Workflow and Time to Treatment and the Effects on Outcome in Endovascular Treatment of Acute Ischemic Stroke: Results from the SWIFT PRIME Randomized Controlled Trial

Mayank Goyal, Ashutosh P Jadhav, Alain Bonafe, Hans Diener, Vitor Mendes Pereira, Elad Levy, Blaise Baxter, Tudor Jovin, Reza Jahan, Bijoy K Menon, …

Radiology, Vol.279(3), pp.888-897

2016-06

DOI: https://doi.org/10.1148/radiol.2016160204

PMID: 27092472

Abstract

Informed Consent

Acute Disease

Administration, Intravenous

Thrombectomy

Time Factors

Humans

Logistic Models

Tissue Plasminogen Activator - administration & dosage

Treatment Outcome

Workflow

Combined Modality Therapy

Stroke - therapy

Purpose To study the relationship between functional independence and time to reperfusion in the Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) trial in patients with disabling acute ischemic stroke who underwent endovascular therapy plus intravenous tissue plasminogen activator (tPA) administration versus tPA administration alone and to investigate variables that affect time spent during discrete steps. Materials and Methods Data were analyzed from the SWIFT PRIME trial, a global, multicenter, prospective study in which outcomes were compared in patients treated with intravenous tPA alone or in combination with the Solitaire device (Covidien, Irvine, Calif). Between December 2012 and November 2014, 196 patients were enrolled. The relation between time from (a) symptom onset to reperfusion and (b) imaging to reperfusion and clinical outcome was analyzed, along with patient and health system characteristics that affect discrete steps in patient workflow. Multivariable logistic regression was used to assess relationships between time and outcome; negative binomial regression was used to evaluate effects on workflow. The institutional review board at each site approved the trial. Patients provided written informed consent, or, at select sites, there was an exception from having to acquire explicit informed consent in emergency circumstances. Results In the stent retriever arm of the study, symptom onset to reperfusion time of 150 minutes led to 91% estimated probability of functional independence, which decreased by 10% over the next hour and by 20% with every subsequent hour of delay. Time from arrival at the emergency department to arterial access was 90 minutes (interquartile range, 69-120 minutes), and time to reperfusion was 129 minutes (interquartile range, 108-169 minutes). Patients who initially arrived at a referring facility had longer symptom onset to groin puncture times compared with patients who presented directly to the endovascular-capable center (275 vs 179.5 minutes, P < .001). Conclusion Fast reperfusion leads to improved functional outcome among patients with acute stroke treated with stent retrievers. Detailed attention to workflow with iterative feedback and aggressive time goals may have contributed to efficient workflow environments. (©) RSNA, 2016 Online supplemental material is available for this article.

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Collaboration types: Domestic collaboration; International collaboration
Citation topics: 1 Clinical & Life Sciences; 1.105 Strokes; 1.105.142 Stroke
Web Of Science research areas: Radiology, Nuclear Medicine & Medical Imaging
ESI research areas: Clinical Medicine

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Title: Analysis of Workflow and Time to Treatment and the Effects on Outcome in Endovascular Treatment of Acute Ischemic Stroke: Results from the SWIFT PRIME Randomized Controlled Trial
Creators: Mayank Goyal - From the Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G., B.K.M.); Departments of Neurology and Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.P.J., T.J.); Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.D.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada (V.M.P.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY (E.L.); Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga, Tenn (B.B.); and Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center (J.L.S.), David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, Calif
Ashutosh P Jadhav - From the Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G., B.K.M.); Departments of Neurology and Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.P.J., T.J.); Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.D.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada (V.M.P.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY (E.L.); Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga, Tenn (B.B.); and Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center (J.L.S.), David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, Calif
Alain Bonafe - From the Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G., B.K.M.); Departments of Neurology and Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.P.J., T.J.); Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.D.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada (V.M.P.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY (E.L.); Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga, Tenn (B.B.); and Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center (J.L.S.), David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, Calif
Hans Diener - From the Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G., B.K.M.); Departments of Neurology and Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.P.J., T.J.); Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.D.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada (V.M.P.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY (E.L.); Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga, Tenn (B.B.); and Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center (J.L.S.), David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, Calif
Vitor Mendes Pereira - From the Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G., B.K.M.); Departments of Neurology and Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.P.J., T.J.); Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.D.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada (V.M.P.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY (E.L.); Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga, Tenn (B.B.); and Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center (J.L.S.), David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, Calif
Elad Levy - From the Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G., B.K.M.); Departments of Neurology and Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.P.J., T.J.); Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.D.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada (V.M.P.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY (E.L.); Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga, Tenn (B.B.); and Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center (J.L.S.), David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, Calif
Blaise Baxter - From the Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G., B.K.M.); Departments of Neurology and Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.P.J., T.J.); Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.D.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada (V.M.P.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY (E.L.); Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga, Tenn (B.B.); and Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center (J.L.S.), David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, Calif
Tudor Jovin - From the Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G., B.K.M.); Departments of Neurology and Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.P.J., T.J.); Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.D.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada (V.M.P.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY (E.L.); Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga, Tenn (B.B.); and Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center (J.L.S.), David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, Calif
Reza Jahan - From the Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G., B.K.M.); Departments of Neurology and Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.P.J., T.J.); Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.D.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada (V.M.P.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY (E.L.); Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga, Tenn (B.B.); and Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center (J.L.S.), David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, Calif
Bijoy K Menon - From the Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G., B.K.M.); Departments of Neurology and Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.P.J., T.J.); Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.D.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada (V.M.P.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY (E.L.); Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga, Tenn (B.B.); and Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center (J.L.S.), David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, Calif
Jeffrey L Saver - From the Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.G., B.K.M.); Departments of Neurology and Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.P.J., T.J.); Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France (A.B.); Department of Neurology, University Hospital of University Duisburg-Essen, Essen, Germany (H.D.); Division of Neuroradiology and Division of Neurosurgery, Department of Medical Imaging and Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada (V.M.P.); Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY (E.L.); Department of Radiology, Erlanger Hospital at the University of Tennessee, Chattanooga, Tenn (B.B.); and Division of Interventional Neuroradiology (R.J.) and Department of Neurology and Comprehensive Stroke Center (J.L.S.), David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, Calif
Publication Details: Radiology, Vol.279(3), pp.888-897
Publisher: United States
Language: English
Resource Type: Journal article
PMID: 27092472
Record Identifier: 991031578044602976