Korean J Radiol.  2018 Oct;19(5):838-848. 10.3348/kjr.2018.19.5.838.

Consensus Statements by Korean Society of Interventional Neuroradiology and Korean Stroke Society: Hyperacute Endovascular Treatment Workflow to Reduce Door-to-Reperfusion Time

• Kim DH
• Kim B
• Jung C
• Nam HS
• Lee JS
• Kim JW
• Lee WJ
• Seo WK
• Heo JH
• Baik SK
• Kim BM
• Rha JH

• KMID: 2418546
• DOI: http://doi.org/10.3348/kjr.2018.19.5.838

Abstract

Recent clinical trials demonstrated the clinical benefit of endovascular treatment (EVT) in patients with acute ischemic stroke due to large vessel occlusion. These trials confirmed that good outcome after EVT depends on the time interval from symptom onset to reperfusion and that in-hospital delay leads to poor clinical outcome. However, there has been no universally accepted in-hospital workflow and performance benchmark for rapid reperfusion. Additionally, wide variety in workflow for EVT is present between each stroke centers. In this consensus statement, Korean Society of Interventional Neuroradiology and Korean Stroke Society Joint Task Force Team propose a standard workflow to reduce door-to-reperfusion time for stroke patients eligible for EVT. This includes early stroke identification and pre-hospital notification to stroke team of receiving hospital in pre-hospital phase, the transfer of stroke patients from door of the emergency department to computed tomography (CT) room, warming call to neurointervention (NI) team for EVT candidate prior to imaging, NI team preparation in parallel with thrombolysis, direct transportation from CT room to angiography suite following immediate decision of EVT and standardized procedure for rapid reperfusion. Implementation of optimized workflow will improve stroke time process metrics and clinical outcome of the patient treated with EVT.

Keyword

Endovascular treatment; Door-to-reperfusion time; Hyperacute stroke; Pre-hospital notification

MeSH Terms

Advisory Committees
Angiography
Benchmarking
Consensus*
Emergency Service, Hospital
Humans
Joints
Reperfusion
Stroke*
Transportation

Figure

• 

  Fig. 1 Customized emergency stroke kit. Kit contains basic equipment for IV tPA administration, such as Actylase, Labetolol, Nicardipine, syringes, IV catheter, normal saline bag, and informed consent. IV tPA = intravenous tissue plasminogen activator

• 

  Fig. 2 Customized EVT kit. Kit contains basic equipment for endovascular procedure at discretion of NI physician, such as syringes, trays, sterile gauze, 3-way check valves, and flushing lines, which could be beneficial in reducing time for preparing procedure in off-hours. EVT = endovascular treatment, NI = neurointervention

• 

  Fig. 3 Flowchart showing workflow and various steps at each stage. CT = computed tomography, CTA = CT angiography, EKG = electrocardiography, EMS = emergency medical services

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