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Updated: Jul 19, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Highly Visible Wall-Timer to Reduce Endovascular Treatment Time for Stroke
Ossama Khazaal1, Mougnyan Cox1, Emily Grodinsky1
1Department of Neurology, University of Pennsylvania, Philadelphia, PA (O.K., E.G., J.D., D.C., E.N.-B., P.R., S.E.K., C.G.F.); Department of Radiology, University of Pennsylvania, Philadelphia, PA (M.C., K.-B.A., J.Y.J., B.A.P., R.H.); Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA (D.K., O.C., J.-K.B.).
Background:
Endovascular therapy for acute ischemic stroke has revolutionized clinical care for patients with stroke and large vessel occlusion, but treatment remains time sensitive. At our stroke center, up to half of the door-to-groin time is accounted for after the patient arrives in the angio-suite. Here, we apply the concept of a highly visible timer in the angio-suite to quantify the impact on endovascular treatment time.
Methods:
This was a single-center prospective pseudorandomized study conducted over a 32-week period. Pseudorandomization was achieved by turning the timer on and off in 2-week intervals. The primary outcome was angio-suite-to-groin time, and secondary outcomes were angio-suite-to-intubation time, groin-to-recanalization time, and 90-day modified Rankin scale. A stratified analysis was performed based on type of anesthesia (ie, endotracheal intubation versus not).
Results:
During the 32-week study period, 97 mechanical thrombectomies were performed. The timer was on and off for 38 and 59 cases, respectively. The timer resulted in faster angio-suite-to-groin time (28 versus 33 minutes; P=0.02). The 5-minute reduction in angio-suite-to-groin was maintained after adjusting for intubation status in a multivariate regression (P=0.02). There was no difference in the 90-day modified Rankin scale between groups. The timer impact was consistent across the 32-week study period.
Conclusions:
A highly visible timer in the angio-suite achieved a meaningful, albeit modest, reduction in endovascular treatment time for patients with stroke. Given the lack of risk and low cost, it is reasonable for stroke centers to consider a highly visible timer in the angio-suite to improve treatment times.
