Study Analyzes Delays in Endovascular Therapy in the IMS III Trial

May 9, 2014—Findings from an evaluation of interval times from onset to reperfusion in patients undergoing endovascular therapy in the International Management of Stroke (IMS) III trial were published by Mayank Goyal, MD, et al online ahead of print in Circulation.

The investigators concluded that important delays were identified before reperfusion in the IMS III trial and that delays decreased as the trial progressed. They found that the use of CT angiography and endovascular treatment in the same center were associated with time savings. These data may help in optimizing workflow in current and future endovascular trials, stated the investigators in Circulation.

The background of the study is that meaningful delays occurred in the IMS III trial and that an analysis of the workflow will identify factors contributing to the in-hospital delays.

As summarized in Circulation, in the endovascular arm of the IMS III trial, the following time intervals were calculated: stroke onset to emergency department (ED) arrival, ED to CT, CT to intravenous tissue plasminogen activator (IV tPA) start, IV tPA start to randomization, randomization to groin puncture, groin puncture to thrombus identification, thrombus identification to start of endovascular therapy, and start of endovascular therapy to reperfusion.

The investigators evaluated the effects on workflow of enrollment time, CT angiography use, interhospital transfers, and intubation.

Delays notably occurred in the time intervals from IV tPA initiation to groin puncture (median, 84 minutes) and from start of endovascular therapy to reperfusion (median, 85 minutes). The CT-to-groin puncture time was significantly shorter during working hours than after. Times from ED to reperfusion and from groin puncture to reperfusion decreased over the trial period. Patients with CT angiography had shorter ED-to-reperfusion and onset-to-reperfusion times. Transfer of patients resulted in a longer onset-to-reperfusion time compared to those treated in the same center. Age, sex, NIHSS, and intubation did not impact delays, reported the investigators in Circulation.