Associations With Puncture to First Pass Time in Ischemic Stroke Patients

Objective: As part of our efforts in ongoing quality improvement, we aimed to identify characteristics associated with puncture to first pass (PTFP) in patients with acute ischemic stroke undergoing thrombectomy, potentially finding opportunities to improve time to treatment. Methods: All patients who had thrombectomies at Harborview Medical Center from 2015 to present, who have available data on PTFP, were included in a deidentified stroke center database. The database was reviewed for patient characteristics including age, sex, mean NIHSS, presence of atrial fibrillation, systolic blood pressure, race, weight, height, BMI, A1C, and LDL. Statistics were performed using non-parametric analysis for univariate associations, and multivariate linear regression. A quality control run chart was created to identify a high yield subset of outliers for review. Results: There were 261 patients included in the analysis. The mean age was 67.8 years (SD 15.0). Average NIHSS on admission was 19.6. Mean PTFP time was 28.4 minutes (SD 15.6), 45% of patients were female. In univariate analyses, significant associations with PTFP were found for age (p=0.0001), systolic blood pressure (p=0.0038), and admitting NIHSS (p=0.0298). Using multivariate regression, older patient age was the only patient characteristic independently associated with increased PTFP; each additional decade was associated with an increase of 1.93 minutes in PTFP (p=0.003). The figure displays the quality control run chart with identification of outliers. Conclusions: In this single-center study we found that among different patient characteristics, only age was independently associated with increased PTFP. There are other characteristics such as individual aortic arch anatomy, not analyzed herein that may also influence PTFP time. Detailed review of outlier cases is ongoing.