(670) Effect of Early Neuroendovascular Team Involvement in Acute Stroke Protocol: A Retrospective Study

Introduction: Early management protocols can improve acute ischemic stroke (AIS) outcomes. Our protocol activates a stroke team, including neuroendovascular interventionists, when a pre-hospital stroke is suspected. Upon patient arrival, the team begins management, with interventionists immediately reviewing images and determining the treatment strategy. This allows for simultaneous decisions regarding eligibility for intravenous thrombolysis (tPA) and endovascular therapy (EVT). This study aimed to evaluate the impact of a protocol involving the early involvement of neuroendovascular interventionists on the outcomes for patients undergoing tPA or EVT for AIS.

Methods: This single-center retrospective study included patients with AIS who were transported to our emergency department and received tPA or EVT between January 2010 and December 2022. The patients were divided into protocol and conventional groups. The primary outcome was a favorable neurological outcome (modified Rankin Scale score of 0-2) at discharge. Secondary outcomes included the time to initiation of treatment with tPA and/or EVT, as applicable to each patient. Logistic regression analysis was performed to estimate the effects of the protocols on patient outcomes.

Results: Overall, 528 eligible patients were divided into the protocol and conventional groups (n = 322 and 206, respectively). Regarding tPA, 239 (74.2%) and 184 (89.3%) patients in the protocol and conventional groups, respectively, received the treatment. The corresponding numbers for EVT were 238 (73.9%) and 166 (80.6%) patients. The proportion of patients with favorable neurological outcomes at discharge was significantly higher in the protocol group than in the conventional group (135 patients [41.9%] vs. 65 patients [31.6%]). The median time from arrival to tPA administration (19.0 [14.0–34.0] min vs 77.5 [52.8–112.0] min) and time to initiation of EVT (51 [36.0–76.0] min vs 91.5 [60.3–187.8] min) were significantly shorter in the protocol group.

Conclusions: Implementation of protocols with the early involvement of neuroendovascular specialists in the emergency room may significantly improve outcomes for patients with AIS treated using tPA or EVT. These protocols lead to faster treatment initiation and better neurological outcomes.