Optimizing mechanical thrombectomy - The impact of cath lab staff turnover on stroke thrombectomy times

Area of Science:

• Neurology
• Cardiovascular Interventions
• Healthcare Operations

Background:

• Increased cath lab staff turnover post-COVID impacted retention of neurology-trained cath lab technicians (neuro-CLTs).
• This study addresses the consequences of this turnover on stroke quality metrics.

Purpose of the Study:

• To investigate the impact of neurology-trained cath lab technicians (neuro-CLTs) on endovascular therapy (EVT) workflow efficiency.
• To compare procedural times between neuro-CLTs and non-neurology-trained technicians (other-CLTs).

Main Methods:

• Retrospective analysis of a prospectively maintained thrombectomy patient database (December 2021 - October 2023).
• Patients undergoing EVT for large vessel occlusion (LVO) stroke were grouped by CLT expertise (neuro-CLT vs. other-CLT).
• Key outcome measures included time from arterial access to first EVT pass and time from cath lab arrival to arterial access.

Main Results:

• Procedures with neuro-CLTs showed faster median times: access to first pass (10 min vs. 15 min, P=.004) and cath lab arrival to access (22 min vs. 27 min, P=.036).
• Neuro-CLTs were associated with a higher likelihood of achieving access to first pass within 10 minutes (47% vs. 25%, P=.009, OR 2.67).
• Overall, neuro-CLTs contributed to a median time saving of 10 minutes from cath lab arrival to first pass.

Conclusions:

• Neurology-trained cath lab technicians enhance EVT workflow efficiency, significantly reducing critical procedure times.
• Findings support the development of structured training programs and competency standards for neuro-CLTs.
• Further multi-center prospective studies are warranted to confirm external validity and impact on patient outcomes.