Introduction: Stroke is the leading cause of disability and fifth leading cause of mortality in the United States. Acute ischemic strokes (AIS) account for 87% of all strokes. Until recently, IV-tPA was the only treatment option available for treating AIS. However, numerous randomized-controlled trials have demonstrated that rapid endovascular treatment (EVT) can improve functional outcomes and reduce mortality in AIS patients over IV-tPA. There are several factors that determine clinical outcome in EVT, the most prominent of which has been time from last known well (LKW)-to-groin puncture.

Methods: We retrospectively reviewed the records of patients transferred to Brigham and Woman’s Hospital for EVT of AIS between January 2015 and October 2015. We compared stroke patients who were managed with the existing workflow and brought to the angiography suite via the emergency department, “traditional,” to patients who were either directly transported to the angiography suite or transported to the angiography suite in an expedited fashion, “direct”. The primary outcome measure was door-to-puncture time. Secondary outcome measures included time from LKW-to-puncture and modified Rankin score (mRS) at discharge.

Results: 25 patients were identified. Of those, 20 were admitted upon arrival, while 5 were expedited to the angiography suite. There was a significant difference in door-to-puncture time (27 versus 76 minutes, p=0.04), favoring the “direct” group. LKW-to-puncture was 250 versus 293 minutes, respectively (p=0.6, not significant due to high variability in pre-hospital time). mRS at discharge was 3.8 versus 4.1, respectively (p=0.8, likely due to short follow-up).

Conclusions: We demonstrate that a substantial time difference exists in the treatment of traditional versus direct AIS patients. Transporting stroke patients directly to the angiography suite may result in significant time saving and lead to better functional outcomes. This should be evaluated in larger prospective studies.

Patient Care: Our research demonstrates that a substantial time difference exists in the treatment of traditional versus direct AIS patients. Transporting stroke patients directly to the angiography suite may result in significant time saving and potentially lead to better functional outcomes for stroke patients. Morever, understanding the importance of time-to-puncture in clinical outcome for AIS patients may lead to widespread hospital protocol changes in terms of how such patients are managed and how access to care may be optimized.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of workflow management in door-to-puncture time for acute ischemic stroke (AIS) patients. 2) Discuss, in small groups, the implications that bypassing the emergency department might have for optimizing outcomes in AIS patients. 3) Propose a novel paradigm that hospitals could implement with respect to how AIS patients are managed upon arrival at the hospital.

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