Abstract Details

Title Door in-Door out Time for Stroke Thrombectomy Transfers in a Large Hub-and-Spoke Network

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S16 - Stroke Management and Outcomes (1:24 PM-1:36 PM)

Poster/Presentation
Number 003

Background The mantra ‘time is brain’ cannot be overstated for patients suffering from acute ischemic stroke. This is especially true for those with large vessel occlusions (LVO) requiring transfer to an endovascular thrombectomy (EVT) capable center.

Objective To analyze real-world data of the impact and determinants of door-in-door out (DIDO) times in a large, hub-and-spoke network.

Design/Methods Individuals were retrospectively identified from a prospectively maintained database from January 2019 to November 2022. DIDO was defined as the time between spoke hospital door in arrival and door out exit. Baseline characteristics, treatments, and outcomes were compared, dichotomizing DIDO at 90 min based in the American Heart Association goal for DIDO ≤90 min for 50% of transfers. Multivariable regression analyses were performed for determinants of 90-day ordinal modified Ranking Scale (mRS) and DIDO.

Results We identified 194 patients transferred for EVT with available DIDO. The median age was 67 (IQR 57-80), and 46% were female. The median NIHSS was 16 (10-20), 50% were treated with intravenous thrombolysis at a spoke, and TICI 2B-3 reperfusion was achieved in 87% at the hub. The median DIDO was 120 min (97-149), with DIDO ≤90 min achieved in 18%. DIDO was a significant determinant of 90-day ordinal mRS (B=0.007, 95%CI=0.001-0.012, p=0.013), even when accounting for last known well-to-spoke door in, spoke door out-to-hub arrival, hub arrival-to-puncture, puncture-to-first pass, age, NIHSS, intravenous thrombolysis, TICI 2B-3, and symptomatic intracranial hemorrhage. Importantly, determinants of DIDO included Black race or Hispanic ethnicity (B=0.918, 95%CI=0.010-1.826, p=0.048), atrial fibrillation or heart failure (B=0.793, 95%CI=0.257-1.329, p=0.004), and basilar LVO location (B=2.528, 95%CI=1.154-3.901, p<0.001).

Conclusions Spoke DIDO was the most important period of time for long term outcomes of LVO stroke patients treated with EVT. Further investigation of the determinants of DIDO is needed to improve systems of care and improve patient outcomes.

Authors/Disclosures
Robert W. Regenhardt, MD, PhD (Massachusetts General Hospital) PRESENTER	Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Rapid Medical. Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Johnson and Bell Trial Lawyers. The institution of Dr. Regenhardt has received research support from National Institutes of Health. The institution of Dr. Regenhardt has received research support from Society of Vascular and Interventional Neurology. The institution of Dr. Regenhardt has received research support from Heitman Foundation.
Rashid A. Ahmed, MD (Upstate University Hospital)	Dr. Ahmed has nothing to disclose.
Thabele M. Leslie-Mazwi, MD	Dr. Leslie-Mazwi has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for World Care Clinical. Dr. Leslie-Mazwi has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Phillips Health Care. Dr. Leslie-Mazwi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for IQVIA. Dr. Leslie-Mazwi has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll.
Alvin Das, MD (Beth Israel Deaconess Medical Center)	Dr. Das has nothing to disclose.
Adam Dmytriw (Massachusetts General Hospital)	No disclosure on file
James Rabinov	No disclosure on file
Christopher Stapleton (Massachusetts General Hospital)	No disclosure on file
Aman Patel	No disclosure on file
Aneesh B. Singhal, MD, FAAN (Massachusetts General Hospital)	An immediate family member of Dr. Singhal has received personal compensation for serving as an employee of Biogen. Dr. Singhal has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Medicolegal Firms. Dr. Singhal has received research support from NIH-NINDS. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received personal compensation in the range of $500-$4,999 for serving as a Honorarium (Education) with Biogen.
Natalia S. Rost, MD, MPH, FAHA, FAAN (Massachusetts General Hospital)	Dr. Rost has received personal compensation in the range of $50,000-$99,999 for serving as an officer or member of the Board of Directors for American Academy of Neurology. Dr. Rost has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke - AHA/ASA Journal. The institution of Dr. Rost has received research support from NIH. Dr. Rost has received publishing royalties from a publication relating to health care.