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Abstract Details

Door in-Door out Time for Stroke Thrombectomy Transfers in a Large Hub-and-Spoke Network
Cerebrovascular Disease and Interventional Neurology
S16 - Stroke Management and Outcomes (1:24 PM-1:36 PM)
003
To analyze real-world data of the impact and determinants of door-in-door out (DIDO) times in a large, hub-and-spoke network. 
The mantra ‘time is brain’ cannot be overstated for patients suffering from acute ischemic stroke. This is especially true for those with large vessel occlusions (LVO) requiring transfer to an endovascular thrombectomy (EVT) capable center.
Individuals were retrospectively identified from a prospectively maintained database from January 2019 to November 2022. DIDO was defined as the time between spoke hospital door in arrival and door out exit. Baseline characteristics, treatments, and outcomes were compared, dichotomizing DIDO at 90 min based in the American Heart Association goal for DIDO ≤90 min for 50% of transfers. Multivariable regression analyses were performed for determinants of 90-day ordinal modified Ranking Scale (mRS) and DIDO.
We identified 194 patients transferred for EVT with available DIDO. The median age was 67 (IQR 57-80), and 46% were female. The median NIHSS was 16 (10-20), 50% were treated with intravenous thrombolysis at a spoke, and TICI 2B-3 reperfusion was achieved in 87% at the hub. The median DIDO was 120 min (97-149), with DIDO ≤90 min achieved in 18%. DIDO was a significant determinant of 90-day ordinal mRS (B=0.007, 95%CI=0.001-0.012, p=0.013), even when accounting for last known well-to-spoke door in, spoke door out-to-hub arrival, hub arrival-to-puncture, puncture-to-first pass, age, NIHSS, intravenous thrombolysis, TICI 2B-3, and symptomatic intracranial hemorrhage. Importantly, determinants of DIDO included Black race or Hispanic ethnicity (B=0.918, 95%CI=0.010-1.826, p=0.048), atrial fibrillation or heart failure (B=0.793, 95%CI=0.257-1.329, p=0.004), and basilar LVO location (B=2.528, 95%CI=1.154-3.901, p<0.001).
Spoke DIDO was the most important period of time for long term outcomes of LVO stroke patients treated with EVT. Further investigation of the determinants of DIDO is needed to improve systems of care and improve patient outcomes. 
Authors/Disclosures
Robert W. Regenhardt, MD, PhD
PRESENTER 		Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genomadix. Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Rapid Medical. Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Johnson and Bell Trial Lawyers. Dr. Regenhardt has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Buckley, Theroux, Kline, & Cooley Trial Lawyers. The institution of Dr. Regenhardt has received research support from National Institutes of Health. The institution of Dr. Regenhardt has received research support from Society of Vascular and Interventional Neurology. The institution of Dr. Regenhardt has received research support from Heitman Foundation.
Rashid A. Ahmed, MD (Upstate University Hospital) Dr. Ahmed has nothing to disclose.
Thabele M. Leslie-Mazwi, MD Dr. Leslie-Mazwi has nothing to disclose.
Alvin Das, MD (Beth Israel Deaconess Medical Center) Dr. Das has nothing to disclose.
Adam Dmytriw (Massachusetts General Hospital) Adam Dmytriw has nothing to disclose.
James Rabinov James Rabinov has nothing to disclose.
Christopher Stapleton (Massachusetts General Hospital) No disclosure on file
Aman Patel Aman Patel has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Microvention. Aman Patel has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Stryker. Aman Patel has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic. Aman Patel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Penumbra.
Aneesh B. Singhal, MD, FAAN (Massachusetts General Hospital) An immediate family member of Dr. Singhal has received personal compensation for serving as an employee of Biogen. Dr. Singhal has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Medicolegal Firms. Dr. Singhal has received research support from NIH-NINDS. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received personal compensation in the range of $500-$4,999 for serving as a Honorarium (好色先生) with Biogen.
Natalia S. Rost, MD, MPH, FAAN, FAHA (Massachusetts General Hospital) Dr. Rost has received personal compensation in the range of $50,000-$99,999 for serving as an officer or member of the Board of Directors for 好色先生. Dr. Rost has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke - AHA/ASA Journal. The institution of Dr. Rost has received research support from NIH. Dr. Rost has received publishing royalties from a publication relating to health care.