Improvements in endovascular stroke treatment workflow over 5 years: ESCAPE to ESCAPE-NA1

Background and PurposeRapid treatment is a major determinant of outcome in acute ischemic stroke patients with large vessel occlusion. We used patient-level data from the ESCAPE and ESCAPE-NA1 trials to evaluate whether and to what extent workflow interval times have improved over time.MethodsData were derived from the ESCAPE and the ESCAPE-NA1 randomized trials. Workflow interval times and reperfusion quality were summarized using descriptive statistics and compared on a patient level between the two trials using the Wilcoxon rank sum test and Fisher's exact test. The effect of patient baseline characteristics, including patient age, sex and stroke severity as measured by the National Institutes of Health Stroke Scale, on workflow times was determined using linear regression.ResultsAll patients from the ESCAPE trial (n = 315) and the ESCAPE-NA1 trials (n = 1105) were included in the analysis. For endovascular interval times, control patients from the ESCAPE trial were excluded. All in-hospital workflow interval times, including door-to-reperfusion times, were significantly shorter in ESCAPE-NA1 (median 91 min [IQR 69-120] vs. 110 [IQR 89-143], P < .001). These improvements were mainly observed in patients directly presenting to an EVT-capable hospital. Onset-to-randomization times did not differ significantly between the two trials (ESCAPE-NA1: median 188 [122-319] vs. ESCAPE: 174 [119-285], P = .152). There was no effect of procedural sedation use, age, sex, stroke severity or evidence of a learning effect over the duration of each trial.ConclusionWorkflow interval times in endovascular stroke treatment have significantly improved over time, particularly in patients directly presenting to an EVT-capable hospital.