• World Neurosurg · Aug 2021

    Improving door-to-puncture time in mechanical thrombectomy with direct care from a neurointerventionalist in the emergency room.

    • Seung Hwan Kim, Taek Min Nam, Ji Hwan Jang, Young Zoon Kim, Kyu Hong Kim, Do-Hyung Kim, Hyungon Lee, Sung-Chul Jin, and Chul Hee Lee.
    • Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea; Department of Neurosurgery, Gyeongsang National University College of Medicine, Jinju, Republic of Korea.
    • World Neurosurg. 2021 Aug 1; 152: e455-e461.

    ObjectiveA shorter door-to-puncture time is an independent predictor of good clinical outcomes in patients with acute ischemic stroke (AIS) who undergo mechanical thrombectomy (MT). We recently initiated a protocol for direct care from neurointerventionalists (NIs) in the emergency department (ED) rather than from non-NI neurologists for patients with AIS. Our aim was to investigate whether NIs, as the first point-of-care physicians for stroke in the ED, could shorten door-to-puncture time compared to non-NI neurologists.MethodsFrom January 2020 to December 2020, 50 patients with AIS underwent MT at our hospital. Patients were divided into 2 groups based on the type of physician who provided initial care for stroke in the ED: (a) NI group (n = 20) and (b) non-NI group (n = 30). The door-to-puncture time was retrospectively analyzed.ResultsThe NI group had a significantly shorter door-to-puncture time than the non-NI group (135.2 ± 50.0 minutes vs. 167.2 ± 54.3 minutes, P = 0.040). A door-to-puncture time of ≤120 minutes was more frequently achieved in the NI group than in the non-NI group (55.0% vs. 23.3%, P = 0.022). Multivariable logistic regression analysis revealed that a door-to-puncture time of ≤120 minutes was independently associated with the NI group (adjusted odds ratio 4.098, 95% confidence interval 1.085-15.479, P = 0.037).ConclusionsOur study showed that NIs, as the first point-of-care stroke physicians in the ED, were associated with shorter door-to-puncture times. We suggest that NIs should be at the forefront of care for patients with AIS in the acute setting by performing triage and deciding on and performing MT.Copyright © 2021 Elsevier Inc. All rights reserved.

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