Improvement of Endovascular Stroke Treatment: A 24-Hour Neuroradiological On-Site Service Is Not Enough

Table 1

Overview of included patients. Phase 0: before establishing a 24 h neuroradiological on-site service in May 2012. Phase 1: after introduction of a 24 h neuroradiological on-site service but before workflow optimization with extensive documentation of procedural times in February 2014. Phase 2: after workflow optimization with extensive documentation of procedural times. NIHSS: national institute for health stroke scale; mRS: modified Rankin scale; ASPECTS Alberta stroke program early CT score. ICA: internal carotid artery; MCA: middle cerebral artery; ACA: anterior cerebral artery; VA: vertebral artery; BA: basilar artery; PCA: posterior cerebral artery. IA: intra-arterial. EST: endovascular stroke treatment. Values expressed as means ± standard deviation if not indicated otherwise.

	Phase 0	Phase 1	Phase 2	value
Demographics
Age (yr) ()	(median, 72.9; IQR, 16.5)	(median, 72.1 IQR, 18.1)	(median, 72.9; IQR, 16.7)	0.673
Male sex ()	52 (54.2%)	63 (50.0%)	43 (43.0%)	0.284
Medical history
Hypertension ()	69 (71.9%)	100 (79.4%)	83 (82.0%)	0.156
Diabetes ()	26 (27.1%)	22 (17.5%)	35 (35.0%)	0.011
Fat metabolism disorder ()	36 (37.5%)	38 (30.2%)	23 (23.0%)	0.087
Adiposity ()	31 (32.3%)	30 (23.8%)	21 (21.0%)	0.166
Nicotine ()	22 (22.9%)	35 (27.8%)	20 (20.0%)	0.381
Cardiovascular disease ()	49 (51.0%)	69 (54.8%)	29 (29.0%)	<0.001
Atrial fibrillation ()	47 (49.0%)	61 (48.4%)	51 (51.0%)	0.924
Prior stroke ()	16 (16.7%)	23 (18.3%)	19 (19.0%)	0.910
Current antiplatelet use ()	26/93 (28.0%)	34/121 (28.1%)	27/82 (32.9%)	0.711
Current anticoagulant use ()	8 (8.3%)	16 (12.7%)	16 (16.0%)	0.264
Clinical baseline
NIHSS on admission	(median, 17.0; IQR, 8)	(median, 18.0; IQR, 6)	(median, 19.0; IQR, 3)	0.935
mRS on admission	(median, 5.0; IQR, 1)	(median, 5.0; IQR, 1)	(median, 5.0; IQR, 1)	0.734
Site of vessel occlusion
Anterior circulation (ICA, MCA, ACA) ()	81 (84.4%)	108 (85.7%)	86 (86.0%)	0.942
Posterior circulation (VA, BA, PCA) ()	15 (15.6%)	18 (14.3%)	14 (14.0%)
Initial ASPECT score	(median, 10.0; IQR, 2)	(median, 9.5; IQR, 1)	(median, 9.0; IQR, 4)	<0.001
Time intervals
Onset to door (min)	(median, 61.0; IQR, 50)	(median, 95.0; IQR, 92)	(median, 79.5; IQR, 73)	0.247
Door to image (min)	(median, 27.0; IQR, 12)	(median, 28.0; IQR, 12)	(median, 22.0; IQR, 10)	0.001
Image to puncture (min)	(median, 60.0; IQR, 33)	(median, 53.0; IQR, 55)	(median, 46.0; IQR, 23)	<0.001
Puncture to revascularization (min)	(median, 64.5; IQR, 68)	(median, 67.5; IQR, 62)	(median, 54.5; IQR, 55)	0.100
Door to revascularization (min)	(median, 171.0; IQR, 86)	(median, 156.0; IQR, 72)	(median, 129.0; IQR, 66)	0.001
Onset to revascularization (min)	(median, 233.5; IQR,121)	(median, 254.5; IQR, 106)	(median, 216.0; IQR, 118)	0.244
Interventional procedures
Systemic thrombolysis ()	69 (71.9%)	87 (69.0%)	67 (67.0%)	0.759
IA thrombolysis ()	34 (35.4%)	28 (22.2%)	9 (9.0%)	<0.001
Stent retriever ()	77 (80.2%)	118 (93.7%)	97 (97.0%)	<0.001
Outcome
Successful revascularization (TICI ≥ 2b) ()	80 (83.3%)	104 (82.5%)	86 (86.0%)	0.771
Good clinical outcome (mRS ≤ 2 d90) ()	31/79 (39.2%)	34/114 (29.8%)	18/78 (23.1%)	0.087
Death (d90) ()	24/79 (30.4%)	38/114 (33.3%)	29/78 (37.2%)	0.664

values < 0.05 were considered significant.