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Direct Transfer to Angiosuite Triage Strategy for Patients Undergoing Mechanical Thrombectomy in a Rural Setting.

Aldo A Mendez1, Mudassir Farooqui1, Andres Dajles1

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Direct admission to angiosuite (DAA) is feasible in rural settings for large vessel occlusion (LVO) stroke patients. This strategy significantly reduces reperfusion times and improves functional outcomes, demonstrating its effectiveness in time-sensitive stroke care.

Keywords:
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Area of Science:

  • Neurology
  • Interventional Radiology
  • Healthcare Management

Background:

  • Direct admission to angiosuite (DAA) aims to decrease stroke time metrics for large vessel occlusion (LVO) transfer patients.
  • Feasibility and effectiveness of DAA in rural settings for LVO patients remain under-established.
  • Fast reperfusion times are critical for LVO patient outcomes.

Purpose of the Study:

  • To evaluate the feasibility and effectiveness of a DAA triage protocol for transferred LVO patients in a rural setting.
  • To compare workflow times and clinical outcomes between DAA and direct emergency department admission (DAED) for LVO patients undergoing mechanical thrombectomy (MT).

Main Methods:

  • A nested interventional cohort study involving adult anterior LVO patients transferred from January 2015 to August 2019.
  • Patients were categorized into DAA for MT and DAED (with or without MT).
  • Analysis of workflow times, clinical, and radiographic outcomes.

Main Results:

  • DAA patients experienced significantly shorter door-to-arterial-puncture (15 vs. 71 min) and puncture-to-recanalization (27 vs. 42.5 min) times.
  • DAA group showed a significant decrease in admission NIHSS score (ΔNIHSS 10 vs. 4) and a higher rate of dramatic clinical improvement (48.9% vs. 23.5%).
  • Comparable functional independence (mRS 0-2) and 90-day mortality rates were observed between groups; however, DAA patients had a significantly higher proportion of excellent functional outcomes (mRS 0-1) after adjusting for confounders.

Conclusions:

  • DAA is a feasible strategy that safely reduces reperfusion times for transferred LVO patients in rural settings.
  • Optimizing workflow through DAA may positively impact functional recovery in patients undergoing mechanical thrombectomy.
  • The DAA protocol demonstrates potential for improving stroke care efficiency and patient outcomes in underserved areas.