Direct to angiosuite strategy versus standard workflow triage for endovascular therapy: systematic review and meta-analysis.

Autor:	Galecio-Castillo M; Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA., Vivanco-Suarez J; Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA., Zevallos CB; Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA., Dajles A; Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA., Weng J; Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA., Farooqui M; Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA., Ribo M; Stroke Unit. Neurology, Hospital Vall d'Hebron, Barcelona, Spain.; Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain., Jovin TG; Neurology, Cooper University Hospital, Camden, New Jersey, USA., Ortega-Gutierrez S; Neurology, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA santy-ortega@uiowa.edu.
Jazyk:	angličtina
Zdroj:	Journal of neurointerventional surgery [J Neurointerv Surg] 2023 Sep; Vol. 15 (e1), pp. e17-e25. Date of Electronic Publication: 2022 Jun 16.
DOI:	10.1136/neurintsurg-2022-018895
Abstrakt:	Background: Reducing stroke workflow times when performing endovascular thrombectomy is associated with improvement in clinical outcomes. We compared outcomes among large vessel occlusion (LVO) stroke patients following the direct to angiosuite (DTAS) strategy versus standard workflow (SW) when undergoing endovascular therapy. Methods: We conducted a systematic review and meta-analysis to compare rates of functional outcomes, reperfusion, symptomatic intracranial hemorrhage (sICH) and stroke workflow metrics. We included observational studies and clinical trials that compared the DTAS strategy versus SW, and at least one outcome of interest was assessed. Clinical, methodological and statistical heterogeneity were measured, and a random-effects model was used. Results: 12 studies were included in the systematic review and 8 in the meta-analysis (n=2890). The DTAS strategy was associated with significant higher odds of good functional outcome at 90 days (47.3% vs 34.9%; OR 1.58, 95% CI 1.16 to 2.14) and a significant average reduction of door-to-puncture (mean differences (MD) -35.09, 95% CI -49.76 to -20.41) and door-to-reperfusion times (MD -32.88, 95% CI -50.75 to -15.01). We found no differences in sICH (OR 0.80, 95% CI 0.53 to 1.20), mortality (OR 1.00, 95% CI 0.60 to 1.67) or successful reperfusion rates (OR 1.37, 95% CI 0.82 to 2.29). Moreover, the DTAS strategy was associated with greater odds of dramatic clinical improvement at 24 hours (OR 1.79, 95% CI 1.15 to 2.79). Conclusion: Patients undergoing the DTAS strategy had a significant reduction in door-to-puncture and door-to-reperfusion times. This resulted in an increased rate of early neurological and 90-day functional recovery without compromising safety in LVO patients undergoing endovascular thrombectomy. Competing Interests: Competing interests: SO-G is consultant for Medtronic, Stryker, and Siemens, and is recipient of grants from NIH-NINDS (RO1NS127114-01), Stryker, Medtronics, Microvention, Penumbra, IschemiaView, Viz.ai, and Siemens. TGJ is adviser and investor for Anaconda, Route92, Viz.ai, FreeOx, Blockade Medical and Methinks. He received personal fees in his role on the Data Safety Monitoring Board and steering committee from Cerenovus and on the screening committee for Contego Medical. He received stock as an advisory board member for Corindus. He received grant support from Medtronic and from Stryker Neurovascular in his capacity as principal investigator for DAWN and AURORA. MR is adviser and shareholder in Anaconda Biomed and Methinks and received grants and personal fees from Medtronic, personal fees from Stryker, Cerenovus, and Apta Targets. (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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