Delay in recognition and treatment of acute ischemic stroke patients has been shown to worsen outcome.  The recent use of an automated CT perfusion analysis tool (RAPID^TM) has been demonstrated to provide rapid and accurate prediction of core stroke volumes and therefore early recognition of large vessel acute ischemic stroke (AIS) patient’s that can potentially benefit from endovascular treatment.  

We reviewed the IRB approved stroke registry of patients who presented to our community based, university affiliated comprehensive stroke center with ischemic strokes during January 2014-July 2018. Patients who underwent neuroendovascular interventions were included.  Patients were divided into three groups based on which imaging modality was used by our stroke team in deciding to activate the neurointervention team.  (Group A-CT ASPECT, Group B-CT Perfusion, Group C-RAPID^TM).    Stroke team activation (Code Stroke) to neurointervention team activation (Code Neurointervention) mean times were analyzed and compared.

There were total of 2423 patients with ischemic strokes.  Of those, 262 patients underwent neuroendovascular interventions. The three groups of patients were: Group A (n=232);  Group B (n=22); and  Group C (n=8). Mean times from Code Stroke to Code Neurointervention were Group A=77 minutes (SD=55, 95% CI= 69-84), Group B=78 minutes (SD=53, 95% CI=53-100), Group C=53 minutes (SD=40, 95% CI=25-80). These groups were statistically significant and there was a definitive suggestion of improved response times from assessment based on RAPID^TM vs the other two modalities (CT ASPECT and CT Perfusion).

Implementation of RAPID^TM software has significantly reduced the time to activate the neurointervention team. Multifactorial time delays may have been reduced with ease of algorithmic decision node. Larger ‘real-life’ practical studies are required to corroborate our findings.