Direct Transfer to Angiosuite in Acute Stroke: Why, When, and How?

Area of Science:

• Neurology
• Interventional Radiology
• Emergency Medicine

Background:

• Reperfusion time is critical for functional outcomes in acute stroke with large vessel occlusion (LVO).
• Direct Transfer to Angiography Suite (DTAS) protocols aim to minimize in-hospital delays.
• DTAS bypasses conventional emergency room imaging, using pre-transfer imaging (flat-panel CT) to rule out hemorrhage or large infarcts.

Purpose of the Study:

• To evaluate the effectiveness and safety of DTAS protocols in reducing in-hospital delays for acute stroke patients.
• To analyze patient selection criteria and imaging strategies within DTAS protocols.
• To assess the impact of DTAS on workflow efficiency and door-to-puncture times.

Main Methods:

• Review of DTAS protocols across different stroke centers.
• Analysis of imaging techniques, including flat-panel CT (FP-CT) and FP-CT angiography.
• Comparison of workflow metrics, such as door-to-puncture time, between DTAS and conventional pathways.

Main Results:

• DTAS protocols significantly reduce in-hospital delays, with door-to-puncture times as low as 16 minutes.
• Patient selection based on stroke severity and early window presentation is crucial for ideal DTAS candidates.
• While effective for workflow, the impact of DTAS on long-term functional outcomes requires further investigation through randomized controlled trials.

Conclusions:

• DTAS is an effective and safe strategy for improving in-hospital workflow in acute stroke care.
• Variations in imaging protocols (e.g., inclusion of FP-CT angiography) exist, impacting arterial puncture rates.
• Further randomized controlled trials are needed to definitively establish the long-term functional benefits of DTAS.