Strategy to Achieve Faster Recanalization for Acute Ischemic Stroke in a University Hospital with Many Constraints

Abstract

Objective: It is essential to improve the in-hospital system and arrangement to achieve recanalization as soon as possible in acute cerebral artery occlusion. In Saitama Prefecture, the stroke emergency transport system began to operate in January 2018 under the prefectural government initiative. At our hospital, also, a trial aiming at rapid, safe, and effective recanalization was initiated in August 2017 in a team consisting mainly of doctors and co-medical staff of the Stroke Center. In this report, the results of the 17-month trial are reviewed. Methods: In all, 127 patients with acute cerebral artery occlusion who underwent endovascular treatment between January 2016 and December 2018 (56 treated before and 71 treated after the initiation of the time-reducing trial) were compared. Interdepartmental conferences and simulations were frequently held with participation primarily by physicians, radiology technicians, and nurses, and information about treatments, operations by various professionals, and therapeutic approaches was shared. The diagnostic and therapeutic processes of the cases experienced were also promptly evaluated and modified for improvements. Results: The time from the arrival of the patient to the injection of recombinant tissue plasminogen activator (rt-PA) was significantly reduced from 90 to 75 minutes, time from the arrival to puncture from 99 to 74 minutes, procedure time from 63 to 50 minutes, and time from the arrival to eventual recanalization from 165 to 130 minutes. The rate of effective recanalization was higher after the initiation of the trial (62% vs. 76%), but the difference was not significant. The percentage of patients with a favorable outcome was also higher after the initiation of the trial (25% vs. 39%). Conclusion: The results of this study indicate that the time of emergency treatment for acute cerebral artery occlusion can be shortened even in a large-scale university hospital with many constraints by sharing of information among departments and making sure that the medical staff of stroke center is well-informed of the standardized therapeutic approach. stroke team approach, rapid recanalization, therapeutic time