ArticleJournal of the American Heart Association2014
Reducing door-to-puncture times for intra-arterial stroke therapy: a pilot quality improvement project.
Article in Journal of the American Heart Association, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
42 citing papers in PubMed, 1 synthesis or guideline pooled it, 77 citations in OpenAlex.
- Clinical prediction of thrombectomy eligibility: A systematic review and 4-item decision tree.International journal of stroke : official journal of the International Stroke Society · 2019Pooled it
- Workflow improvements from automated large vessel occlusion detection algorithms are dependent on care team engagement.Journal of neurointerventional surgery · 2026Trial
- Automated Large Vessel Occlusion Detection Software and Thrombectomy Treatment Times: A Cluster Randomized Clinical Trial.JAMA neurology · 2023Trial
- Review
- The Role of Videoconferencing Teleconsultation in Improving Transfer Efficiency and Functional Outcomes in Rural Stroke Care: Retrospective Cohort Study.JMIR mHealth and uHealth · 2026Article
- CT-to-CT angiography time-an easy target for acute stroke pathway improvement: a retrospective analysis of time from CT to CT angiography in thrombectomy for ischemic stroke.The British journal of radiology · 2026Article
- Increased door-to-puncture time during off-duty hours results in poor treatment outcomes for acute ischemic stroke: A subanalysis of the K-NET registry.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2026Article
- The implementation of an artificial intelligence-based software for large vessel occlusion stroke improves door-to-puncture time at a comprehensive stroke center.Internal and emergency medicine · 2025Article
- Direct to hybrid CT-angiosuite (Nexaris) reduces treatment time for stroke thrombectomy (Direct-ST): A prospective simulation study.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2025Article
- Mechanical thrombectomy for acute ischemic stroke performed without continuous saline flushes and using moderate sedation: The TOOFAST technique.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2025Article
- Reducing Door-to-Puncture Times for Mechanical Thrombectomy in a Large Tertiary Hospital.Neurology. Clinical practice · 2024Article
- Epidemiology, organization, diagnosis and treatment of acute ischemic stroke.European journal of radiology open · 2023Article
- Current and future trends in acute ischemic stroke treatment: direct-to-angiography suite, middle vessel occlusion, large core, and minor strokes.European journal of radiology open · 2023Article
- Extended Multimodal Flat Detector CT Imaging in Acute Ischemic Stroke: A Pilot Study.Journal of digital imaging · 2023Article
- Reduced Workflow Times for Reperfusion Therapy After Acute Ischemic Stroke Using a Visual Task Management Application.Stroke (Hoboken, N.J.) · 2023Article
- A Decade of Improvement in Door-to-Puncture Times for Mechanical Thrombectomy But Ongoing Stagnation in Prehospital Care.Stroke (Hoboken, N.J.) · 2023Article
- Viz.ai Implementation of Stroke Augmented Intelligence and Communications Platform to Improve Indicators and Outcomes for a Comprehensive Stroke Center and Network.AJNR. American journal of neuroradiology · 2023Article
- Optimizing Door-to-Groin Puncture Time: The Mayo Clinic Experience.Mayo Clinic proceedings. Innovations, quality & outcomes · 2022Article
- Impact of COVID-19 on emergency department management of stroke and STEMI. A narrative review.The American journal of emergency medicine · 2022Review
- The effectiveness of systemic and endovascular intra-arterial thrombectomy protocol for decreasing door-to-recanalization time duration.Journal of cerebrovascular and endovascular neurosurgery · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDelays to intra-arterial therapy (IAT) lead to worse outcomes in stroke patients with proximal occlusions. Little is known regarding the magnitude of, and reasons for, these delays. In a pilot quality improvement (QI) project, we sought to examine and improve our door-puncture times. METHODS AND
resultsFor anterior-circulation stroke patients who underwent IAT, we retrospectively calculated in-hospital time delays associated with various phases from patient arrival to groin puncture. We formulated and then implemented a process change targeted to the phase with the greatest delay. We examined the impact on time to treatment by comparing the pre- and post-QI cohorts. One hundred forty-six patients (93 pre- vs. 51 post-QI) were analyzed. In the pre-QI cohort (ie, sequential process), the greatest delay occurred from imaging to the neurointerventional (NI) suite ("picture-suite": median, 62 minutes; interquartile range [IQR], 40 to 82). A QI measure was instituted so that the NI team and anesthesiologist were assembled and the suite set up in parallel with completion of imaging and decision making. The post-QI (ie, parallel process) median picture-to-suite time was 29 minutes (IQR, 21 to 41; P<0.0001). There was a 36-minute reduction in median door-to-puncture time (143 vs. 107 minutes; P<0.0001). Parallel workflow and presentation during work hours were independent predictors of shorter door-puncture times.
conclusionsIn-hospital delays are a major obstacle to timely IAT. A simple approach for achieving substantial time savings is to mobilize the NI and anesthesia teams during patient evaluation and treatment decision making. This parallel workflow resulted in a >30-minute (25%) reduction in median door-to-puncture times.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.