LAUSR

Background and Purpose: Bypassing the emergency department (ED) and the CT suite by directly transporting to the neuroangiography suite for imaging assessment and treatment may shorten reperfusion times while maintaining proper patient selection. Methods: Patients from prospectively collected databases of 4 international comprehensive stroke centers with large vessel occlusion strokes transferred for endovascular therapy (ET) were identified and divided into 2 groups:(1) Direct to angio-suite (DTAS) and (2) standard protocol including CT+/-CTA/CTP. Only patient with anterior circulation strokes, pre-mRS 0-2 and baseline NIHSS The groups were matched for age and baseline NIHSS ≥6 were included. Baseline characteristics, time metrics and outcomes were compared. Results: 548 patients (274 pairs) were included in the analysis. Baseline characteristics were well-balanced. DTAS patients had shorter median picture-to-puncture (14 [8-20] vs 37 [25-50] minutes, p<0.001)and door-to-reperfusion (68 [57-91.5] vs 100.5 [74-140] minutes,p<0.001)times. In terms of outcomes, DTAS patients had higher rates of successful reperfusion (mTICI 2b-3, 87.2% vs 73.3%, p<0.001) and full reperfusion (mTICI 2c-3, 51.3% vs 38.3%, p=0.004), and lower rates of parenchymal hematomas (14% vs 27%, p<0.001). There were no differences between groups in rates of good outcome (90-day mRS-0-2, 39.2% vs 38.5%, p=0.87) and 90-day mortality (24.2% vs 24.9%, p=0.87). Conclusions: DTAS is safe, feasible and an effective strategy to reduce treatment times. The clinical benefit of this approach should be assessed in a prospective randomized trial.