STEPS-T Program Improves Endovascular Treatment Outcomes of Acute Ischemic Stroke; A 6-Year Study

Background: Early endovascular recanalization of occluded vessels in acute ischemic stroke (AIS) is a major contributor to good clinical outcome. We report the analysis of all AIS patients throughout a 6-year experience following the deployment of a quality initiative aiming at improving care, speed and maintaining quality for AIS treatment. Methods: Using a prospectively collected endovascular database at a comprehensive stroke center between 2012 and 2017, workflow/outcomes were recorded. There were no exclusion criteria. During the first year, a quality program employing "digital-object" technology, staff education, and workflow improvement was implemented to reduce time-to-treatment. Using electronic recording, workflow times were collected for onset (T_O), CT (T_CT), door (T_D), angiography-suite (T_A), groin puncture (T_G), DSA (T_DSA), and recanalization (T_R). Recanalization time (T_G-T_R) and workflow intervals were compared at Year 1 and 6. Results: Analysis of 382 patients (aged 71.3 ± 12.9) undergoing mechanical thrombectomy for AIS (206 male and 176 female) was performed. Recanalization time was significantly reduced from 82 min in 2012 to 34 min by 2017 (IQR 52-117 min and 23-49 min), a 59% reduction (P < 0.001). Further, consistent year-over-year reductions in setup time (T_A-T_G) (44% improvement) and T_CT to T_A times were observed. During the same period, clinical outcome significantly improved year-over-year as measured with the modified Rankin Scale 0-2 (33, 37, 38, 41, 53, and 58%). Conclusions: Significant improvements were observed following the deployment of a quality initiative enabling iterative evidence-based process improvements, thereby sustaining significant reductions in time-to-treat and improved clinical outcomes for AIS patients.