Door-to-puncture time in ischemic stroke with large vessel occlusion in France: Patient and hospital factors

The efficacy of endovascular therapy (EVT) in reducing disability is strongly time-dependent. Door to groin puncture (DTP) time has been reported to be a reliable parameter to assess the delay between admission and treatment initiation and can be shortened via faster, more optimized workflow. We aimed to assess the DTP time in France and have analyzed potentially associated factors at both patient and hospital levels.

From January 2020 to December 2022, data were collected in the prospective, multi-centered, ongoing Endovascular Treatment in Ischemic Stroke (ETIS) registry. All patients directly admitted to comprehensive stroke centers with large vessel occlusion treated by EVT were included in the analysis and their DTP times were analyzed. We investigated hospital-related factors (prenotification, patient's hospital arrival location, type of imaging, number of available angiosuites, type of anesthesia) and patient-related factors, which could affect DTP time.

Among 3847 patients from 28 centers [mean age: 71.2; median NIHSS: 16 (10-20)], the median DTP time was 105minutes (IQR: 84 to 137). Pre-stroke mRS>1, admission during off-hours and admission to centers equipped with only one dedicated angiosuite were associated with a longer DTP time. Centers not equipped with an emergency department had a significantly shorter DTP time.

The median DTP time in France is 105min. Further efforts, such as increasing the number of available angiosuites in CSCs, and implementing direct imaging paradigms should be applied to optimize workflows and to reduce DTP time, a major marker of the efficacy of comprehensive stroke centers.