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Sudhair Abbas Bangash
Naeem Ullah
Dr. Abdul Wadood Kakar
Dr. Masooda Fatima
Dr. Hira Amin
Dr. Nikhilesh Jain


Cerebrovascular Accident, Ischemic Stroke, Acute Stroke, Door-To-Needle Time, Intravenous Fibrinolysis


Introduction: Time plays a crucial role in the success of reperfusion treatments for acute ischemic stroke. Despite clinical guidelines recommending prompt intervention, only about one-third of patients receive fibrinolysis within ≤ 60 minutes. This study aims to outline our experience in implementing a specific protocol for acute ischemic stroke treatment and assess its impact on door-to-needle times.

Methods: Starting at the conclusion of 2015, a series of measures were gradually introduced to reduce response times and optimize care for acute ischemic stroke. This included the implementation of a dedicated neurovascular team. Performance times were compared before (2013-2015) and after (2017-2019) the introduction of the protocol.

Results: A total of 182 patients were included before and 249 after the implementation of the protocol. With the introduction of all measures, the overall median door-to-needle time reduced to 45 minutes (previously 74 minutes, a 39% reduction, p < 0.001). Notably, 73.5% of patients were treated within ≤ 60 minutes, representing a 47% increase compared to the pre-protocol period (p < 0.001). The overall time to treatment (symptom-to-needle onset) decreased by an average of 20 minutes (p < 0.001).

Conclusions: The measures incorporated into our protocol led to a significant and sustained reduction in door-to-needle times, though opportunities for further improvement persist. Established mechanisms for outcome monitoring and continuous enhancement will pave the way for ongoing progress in acute ischemic stroke care

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