Analysis of workflow and time to treatment and the effects on outcome in endovascular treatment of acute ischemic stroke: Results from the SWIFT PRIME randomized controlled trial

The SWIFT PRIME investigators are as follows

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130 Scopus citations

Abstract

Purpose: To study the relationship between functional independence and time to reperfusion in the Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) trial in patients with disabling acute ischemic stroke who underwent endovascular therapy plus intravenous tissue plasminogen activator (tPA) administration versus tPA administration alone and to investigate variables that affect time spent during discrete steps. Materials and Methods: Data were analyzed from the SWIFT PRIME trial, a global, multicenter, prospective study in which outcomes were compared in patients treated with intravenous tPA alone or in combination with the Solitaire device (Covidien, Irvine, Calif). Between December 2012 and November 2014, 196 patients were enrolled. The relation between time from (a) symptom onset to reperfusion and (b) imaging to reperfusion and clinical outcome was analyzed, along with patient and health system characteristics that affect discrete steps in patient workflow. Multivariable logistic regression was used to assess relationships between time and outcome; negative binomial regression was used to evaluate effects on workflow. The institutional review board at each site approved the trial. Patients provided written informed consent, or, at select sites, there was an exception from having to acquire explicit informed consent in emergency circumstances. Results: In the stent retriever arm of the study, symptom onset to reperfusion time of 150 minutes led to 91% estimated probability of functional independence, which decreased by 10% over the next hour and by 20% with every subsequent hour of delay. Time from arrival at the emergency department to arterial access was 90 minutes (interquartile range, 69-120 minutes), and time to reperfusion was 129 minutes (interquartile range, 108-169 minutes). Patients who initially arrived at a referring facility had longer symptom onset to groin puncture times compared with patients who presented directly to the endovascular-capable center (275 vs 179.5 minutes, P < .001). Conclusion: Fast reperfusion leads to improved functional outcome among patients with acute stroke treated with stent retrievers. Detailed attention to workflow with iterative feedback and aggressive time goals may have contributed to efficient workflow environments.

Original languageEnglish (US)
Pages (from-to)888-897
Number of pages10
JournalRadiology
Volume279
Issue number3
DOIs
StatePublished - Jun 2016

Bibliographical note

Funding Information:
Thomas Devlin, Chattanooga Center for Neurologic Research and Erlanger Hospital, U.S.; Vivek Reddy, University of Pittsburgh Medical Center (UPMC), U.S.; Adnan Siddiqui, University of Buffalo Neurosurgery (UBNS) and Buffalo General Hospital, U.S.; Alain Bonafé, CHU Montpellier–Hôpital Gui de Chauliac, France; Richard Du Mesnil de Rochemont, Klinikum der Johann Wolfgang Goethe-Universität, Germany; Raul Nogueira, Emory University, Grady Medical Center, U.S.; Demetrius Lopes, Rush University Medical Center, U.S.; Jeffrey Carpenter, West Virginia University Hospital, U.S.; Christian Weimar, Universitätsklinikum Essen, Germany; Gernot Reimann, Klinikum Dortmund, Germany; Wayne Clark, Oregon Health and Sciences University (OHSU), U.S.; Ronald Budzik, Ohio Health Research Institute and Riverside Methodist Hospital, U.S.; M. Shazam Hussain, Cleveland Clinic Cerebrovascular Center, U.S.; Peter Ringleb, Universitätsklinikum Heidelberg and Neurologische Klinik und Poliklinik, Germany; Indrani Acosta, Florida Hospital, U.S.; Robert Ecker, Maine Medical Center, U.S.; Christian Ramsey, Central Baptist Hospital, U.S.; Panagi-otis Papanagiotou, Klinikum Bremen-Mitte, Germany; Brian-Fred Fitzsimmons, Medical College of Wisconsin (MCW) and Froedtert Memorial Lutheran Hospital, U.S.; Vivek Deshmukh, Providence Brain and Spine Institute, U.S.; Ameer Hassan, Valley Baptist Medical Center, U.S.; Olav Jansen, Universitätsklinikum Kiel, Germany; Luca Remonda, Kantonsspital Aarau, Switzerland; Sid Starkman, UCLA and Ronald Reagan UCLA Medical Center, U.S.; Dileep Yav-agal, University of Miami and Jackson Memorial Hospital, U.S.; Juan Arenillas, Hospital Clinico Universitario de Valladolid, Spain; Casper Brekenfeld, Universitätsklinikum Hamburg-Ep-pendorf, Germany; Bharathi Jagadeesan, Hen-nepin County Medical Center (HCMC), U.S.; Eric Deshaies, State University of New York (SUNY) Upstate, U.S.; Mouhammad Jumaa, Promedica Toledo Hospital, U.S.; Ajit Puri, University of Massachusetts Medical Center, U.S.; Coleman Martin, Saint Luke’s Hospital, U.S.; Hamed Farid, St Jude Medical Center, U.S.; Ali Malek, Tenet Health Systems, U.S.; Klaus Hansen, Rigshospitalet Copenhagen University Hospital, Denmark; Monika Killer-Oberpfalzer, Universitätsklinikum Christian Doppler Klinik Salzburg, Austria; Sascha Prothmann, Klinikum rechts der Isar-Technische Universität München, Germany; Hans-Peter Haring, Landes-Nerven-klinik Wagner-Jauregg, Austria; and Grethe Andersen, Aarhus University Hospital, Denmark.

Funding Information:
Activities related to the present article: institution received payment from Covidien and Medtronic; author received payment from Co-vidien and Stryker for consulting. Activities not related to the present article: author received payment from Microvention for consulting; author received payment from GE Healthcare for patents; author has stock or stock options in Quikflo Health. Other relationships: disclosed no relevant relationships. A.P.J. disclosed no relevant relationships. A.B. Activities related to the present article: author received payment from Medtronic. Activities not related to the present article: author received payment from Stryker. Other relationships: disclosed no relevant relationships. H.D. Activities related to the present article: author received payment from Covidien as the European co-principal investigator for the SWIFT PRIME study. Activities not related to the present article: author received support from Abbott, Allergan, Astra-Zeneca, Bayer Vital, BMS, Boehringer Ingel-heim, CoAxia, Corimmun, Covidien, Daiichi-Sankyo, D-Pharm, Fresenius, GlaxoSmithKline, Janssen-Cilag, Johnson & Johnson, Knoll, Lilly, MSD, Medtronic, MindFrame, Neurobiological Technologies, Novartis, Novo-Nordisk, Paion, Parke-Davis, Pfizer, Sanofi-Aventis, Schering-Plough, Servier, Solvay, St. Jude, Syngis, Talec-ris, Thrombogenics, WebMD Global, Wyeth and Yamanouchi, GSK, and Lundbeck. Other relationships: disclosed no relevant relationships. V.M.P. Activities related to the present article: author received payment from Medtronic as principal investigator of the trial. Activities not related to the present article: author received payment from Stryker. Other relationships: disclosed no relevant relationships. E.L. Activities related to the present article: author received payment from Covidien for training and lectures. Activities not related to the present article: author was the national principal investigator for SWIFT PRIME; author received payment from Pulsar and Blockade Medical for consulting; author received payment from Abbott for training; author received other from Stryker, NeXtGen Biologics, and MEDX for advisory board participation; author received payment from Renders Medical for serving as an expert witness. Other relationships: disclosed no relevant relationships. B.B. Activities related to the present article: author received payment from Covidien for consulting. Activities not related to the present article: author received payment from Penumbra, Stryker, and Silk Road for consulting. Other relationships: author has a patent regarding devices and methods for perfusion therapy. T.J. Activities related to the present article: author received nonfinancial support from Covidien Neurovascular; author received payment from Covidien Neurovascular for travel expenses. Activities not related to the present article: author received payment from Silk Road Medical for advisory board participation; author owns stock in Silk Road Medical; author received nonfinancial support from Covidien Neurovascular; author received payment from Covidien Neurovascular, Stryker Neurovascular, and REVASCAT for travel expenses; author received nonfinancial support from Stryker Neurovascular; author received payment from Air Liquide for consulting; author received nonfinancial support from the Fundacio Ictus Malaltia Vascular. Other relationships: disclosed no relevant relationships. R.J. Activities related to the present article: author received payment from Medtronic Neurovascular; author received support from Medtronic Neurovascular for travel support. Activities not related to the present article: author received payment from Medtronic Neurovascular for con- sulting, lectures, and educational presentations. Other relationships: disclosed no relevant relationships. B.K.M. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: institution received a grant from Covidien; author received a grant from PRoveIT. Other relationships: author has a patent pending for systems of triage in acute stroke. J.L.S. Activities related to the present article: institution received a grant, consulting fees, and travel support from Medtronic. Activities not related to the present article: author received payment from Stryker and Neuravia for consulting; author received payment from Medtronic for lectures; author has stock or stock options in Cognition Medical. Other relationships: disclosed no relevant relationships.

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