{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T15:29:27Z","timestamp":1788449367517,"version":"build-2803163510"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["SVIN"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Systems of care surrounding endovascular therapy for stroke have garnered much attention in recent years. In\u2010hospital metrics, such as \u201cdoor\u2010to\u2010puncture\u201d and procedure times have been areas for quality improvement. The temporal trend and clinical significance of prehospital \u201conset\u2010to\u2010door\u201d time, however, remains unknown.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">We performed a systematic review of time metric data from all published randomized controlled and investigational device exemption trials involving endovascular therapy for stroke between 2005 and 2019 (n=26). Second, we conducted a record\u2010level observational analysis on a total of 3512 patients from 3 real\u2010world registries (Mechanical Embolus Removal in Cerebral Ischemia [MERCI], Thrombectomy REvascularization of Large Vessel Occlusions in Acute Ischemic Stroke [TREVO], and TREVO Stent\u2010Retriever Acute Stroke [TRACK]), together with 4 prospective trials (MERCI trial, Multi\u2010MERCI, TREVO\u2010EU, and TREVO\u20102). Only patients receiving mechanical thrombectomy within 9\u00a0hours from onset\u2010to\u2010puncture time were included. Predictors of good outcome were identified using generalized linear mixed modeling.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Door\u2010to\u2010puncture times (slope=\u22125.83\u00a0min\/y; R\n              <jats:sup>2<\/jats:sup>\n              =0.25;\n              <jats:italic>P<\/jats:italic>\n              =0.046), procedure times (slope=\u22123.78\u00a0min\/y; R\n              <jats:sup>2<\/jats:sup>\n              =0.54;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), and onset\u2010to\u2010reperfusion times (slope=\u221211.82\u00a0min\/y; R\n              <jats:sup>2<\/jats:sup>\n              =0.57;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) improved over the years among previously published randomized controlled trials\/investigational device exemption trials from 2005 to 2019. The prehospital metric of onset\u2010to\u2010door time, however, remained statistically unchanged (slope=1.03\u00a0min\/y; R\n              <jats:sup>2<\/jats:sup>\n              &lt;0.01;\n              <jats:italic>P<\/jats:italic>\n              =0.806). Pooled analysis from record\u2010level data demonstrated a similar temporal trend where door\u2010to\u2010puncture, procedure, and onset\u2010to\u2010reperfusion times declined by an average of 12\u00a0minutes (R\n              <jats:sup>2<\/jats:sup>\n              =0.45;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001), 6\u00a0minutes (R\n              <jats:sup>2<\/jats:sup>\n              =0.27;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001), and 8\u00a0minutes per year (R\n              <jats:sup>2<\/jats:sup>\n              =0.18;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001), respectively, over a similar time period. Time from onset to door, however, did not improve (3.6\u00a0min\/y; R\n              <jats:sup>2<\/jats:sup>\n              =0.34;\n              <jats:italic>P<\/jats:italic>\n              =0.005). In a backward\u2010selection regression model, onset\u2010to\u2010door time was found to be a significant predictor of patient outcomes, where every hour delay in hospital arrival correlated with a 14% reduction in the odds of a good outcome.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\u201cDoor\u2010to\u2010puncture\u201d and procedure times have seen significant improvements over the past decade. The prehospital component of \u201conset\u2010to\u2010door\u201d time, however, has remained stagnant. This presents an unrealized opportunity to enhance patient outcomes through improved systems of care in the prehospital setting.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/svin.122.000561","type":"journal-article","created":{"date-parts":[[2022,11,29]],"date-time":"2022-11-29T10:59:52Z","timestamp":1669719592000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["A Decade of Improvement in Door\u2010to\u2010Puncture Times for Mechanical Thrombectomy But Ongoing Stagnation in Prehospital Care"],"prefix":"10.1161","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1745-2666","authenticated-orcid":false,"given":"Chung\u2010Huan","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Neuroscience Queens Medical Center Honolulu HI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama O.","family":"Zaidat","sequence":"additional","affiliation":[{"name":"Neuroscience Department Bon Secours Mercy Health St. Vincent Medical Center Toledo OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia C.","family":"Castonguay","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Toledo Toledo OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erol","family":"Veznedaroglu","sequence":"additional","affiliation":[{"name":"Department of Neuroscience Drexel University Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald F.","family":"Budzik","sequence":"additional","affiliation":[{"name":"Department of Radiology Ohio Health Riverside Methodist Hospital Columbus OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joey","family":"English","sequence":"additional","affiliation":[{"name":"California Pacific Medical Center San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blaise","family":"Baxter","sequence":"additional","affiliation":[{"name":"Department of Radiology Lehigh Valley Health Network Allentown PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raul G.","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Department of NeurologyUniversity of Pittsburgh Medical Center Stroke InstituteUniversity of Pittsburgh Medical CenterPittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton\u00edn","family":"Krajina","sequence":"additional","affiliation":[{"name":"Charles University Hospital Hradec Kralove Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Bartolini","sequence":"additional","affiliation":[{"name":"Department of Radiology Lausanne University Hospital Lausanne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David S.","family":"Liebeskind","sequence":"additional","affiliation":[{"name":"Department of Neurology and Comprehensive Stroke Center David Geffen School of Medicine University of California Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wade","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matt","family":"Koenig","sequence":"additional","affiliation":[{"name":"Department of Neuroscience Queens Medical Center Honolulu HI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Jenkins","sequence":"additional","affiliation":[{"name":"Stryker Neurovascular Fremont CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rishi","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Neurology WellStar Health System Marietta GA 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Interventional acute stroke therapy with the Merci Retriever embolectomy device: results from 1000 patients in an open label prospective multicenter registry. Paper presented at: International Stroke Conference; 2011; Los Angeles CA. 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A unique signature of cardiac\u2010induced cranial forces during acute large vessel stroke and development of a predictive model. Neurocrit Care. 2020;33:58\u201063.","journal-title":"Neurocrit Care."},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.033053"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2103879"}],"container-title":["Stroke: Vascular and Interventional Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/SVIN.122.000561","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T15:39:47Z","timestamp":1715614787000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/SVIN.122.000561"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":35,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,1]]}},"alternative-id":["10.1161\/SVIN.122.000561"],"URL":"https:\/\/doi.org\/10.1161\/svin.122.000561","relation":{},"ISSN":["2694-5746"],"issn-type":[{"value":"2694-5746","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1]]},"assertion":[{"value":"2022-06-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-09-13","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-29","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e000561"}}