Abstract WP359: Achieving Target: Stroke Honor Roll Status through the Utilization of 9 Best Practice Strategies

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jennifer Garland
Keyword(s):  
Brain Imaging ◽  
Best Practice ◽  
Rapid Acquisition ◽  
Rapid Access ◽  
Honor Roll ◽  
Stroke Team ◽  
Data Feedback ◽  
National Quality ◽  
Primary Stroke Center ◽  
Stroke Center

Background: Target: Stroke is a national quality initiative of the American Heart Association/American Stroke Association with the goal of improving <60 minute door-to-needle times (DTN) for at least 50% of patients receiving IV rt-PA. (AHA/ASA, 2012) Purpose: To improve DTN times <60 minutes at an urban Primary Stroke Center in South California through the utilization of the Target: Stroke national quality initiative. Methods: Retrospective data analysis for 11 IV rt-PA receiving patients in the Get With The Guidelines-Stroke (GWTG-Stroke) database from 11/01/2011 to 01/31/2012. Employment of 9 Target: Stroke Best Practice Strategies: Advance Hospital Notification by EMS (Emergency Medical Services), Rapid Triage Protocol and Stroke Team Notification, Single Call Activation System, Stroke Tools, Rapid Acquisition and Interpretation of Brain Imaging, Rapid Laboratory Testing, Rapid Access to Intravenous IV rt-PA, Team-Based Approach, and Prompt Data Feedback. Results: The hospital received advanced hospital notification by EMS for 10 out of 11 (90.9%) IV rt-PA receiving patients. 100% of the patients were rapidly triaged, the stroke team was notified via single call activation & overhead page (stroke alert), and the appropriate thrombolytic stroke order sets were implemented (Stroke Tools). Rapid acquisition and interpretation of brain imaging were measured. CT Scan order to CT complete turn-around-time (TAT) averaged 12 minutes. CT Complete to CT Read TAT averaged 11.33 minutes.Average PT/INR and PTT TATs were 26.1 minutes. Rapid access to intravenous IV rt-PA was mixed by the Emergency Department pharmacist at the bedside for 100% of patients. The Team-Based Approach and prompt Data Feedback were practiced by holding monthly Stroke Steering Committee meetings that included interdisciplinary team members and disseminating data. Eight out of eleven (72.7%) acute ischemic stroke patients treated with IV rt-PA received the medication <60 minutes. Median door-to-needle (DTN) time for patients treated with IV rt-PA: 42 minutes. Conclusion: By employing 9 Target: Stroke Best Practice Strategies at an urban Primary Stroke Center in South California, the hospital was able to achieve Target: Stroke Honor Roll status from 11/01/2011 to 01/31/2012.

Abstract T P260: Confirmation: The Target Stroke Best Practice Strategies Work

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Nojan Valadi ◽  
Alexis Thomas
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Process Improvement ◽  
Best Practice ◽  
Stroke Patients ◽  
High Performers ◽  
Process Implementation ◽  
Honor Roll ◽  
Stroke Team ◽  
Stroke Center

Background: A recent national push for optimizing stroke center performance led by the efforts of AHA/ASA to recognize high performers with the Target Stroke Honor Roll recognition have focused on achieving expedited treatment for stroke with door-to-needle (DTN) time of ≤60 minutes.Our organization recognized the need to optimize our performance and set an initial goal of achieving DTN time of ≤60 minutes in greater than 50% of our patients. The Target Stroke Initiative by the AHA/ASA identified 10 key strategies for best practice associated with reducing DTN times. Our organization adopted and implemented all of these strategies over a 30-day period. Methods: The Target Stroke best practice strategies were implemented over a 30-day period, and the Stroke Team worked collaboratively to identify other weaknesses needing to be addressed. DTN times ≤60 minutes from the 12 months prior to process improvement implementation were compared with the first 2 months post implementation. Results: There were 345 ischemic stroke patients treated at our facility during the 12 month period prior to the process implementation, with a total of 14 patients (1.12 per month) treated with tPA. The percentage of patients treated with tPA was 4%, and the percentage of patients treated with DTN ≤60 minutes was 0%. Over the two months following process implementation, 68 ischemic stroke patients were treated at our facility, with 11 patients treated with tPA (5.5 per month). The percentage of stroke patients treated with tPA was 16%, with 70% of patients treated with DTN ≤60 minutes. Conclusion: This study serves as confirmation that collaboration and implementation of the 10 key strategies for best practice as outlined by the Target Stroke Initiative, coupled with changes to identified areas of weakness, can improve and expedite the care of patients with acute ischemic stroke. This can substantially improve DTN times, as well as the overall number and percentage of patients that receive thrombolysis with a hopeful impact on their outcome as well as Target Stroke Honor Roll recognition for the facility. In conclusion, we recommend implementation of these best practice strategies to other facilities.

In-Hospital Stroke Care: A Six-Year Community-Based Primary Stroke Center Experience

2021 ◽  
pp. 194187442110070
Author(s):  
Felix Ejike Chukwudelunzu ◽  
Bart M Demaerschalk ◽  
Leonardo Fugoso ◽  
Emeka Amadi ◽  
Donn Dexter ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Statistical Significance ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Community Based ◽  
Chi Square ◽  
Stroke Team ◽  
Primary Stroke Center ◽  
Stroke Center

Background and purpose: In-hospital stroke-onset assessment and management present numerous challenges, especially in community hospitals. Comprehensive analysis of key stroke care metrics in community-based primary stroke centers is under-studied. Methods: Medical records were reviewed for patients admitted to a community hospital for non-cerebrovascular indications and for whom a stroke alert was activated between 2013 and 2019. Demographic, clinical, radiologic and laboratory information were collected for each incident stroke. Descriptive statistical analysis was employed. When applicable, Kruskal-Wallis and Chi-Square tests were used to compare median values and categorical data between pre-specified groups. Statistical significance was set at alpha = 0.05. Results: There were 192 patients with in-hospital stroke-alert activation; mean age (SD) was 71.0 years (15.0), 49.5% female. 51.6% (99/192) had in-hospital ischemic and hemorrhagic stroke. The most frequent mechanism of stroke was cardioembolism. Upon stroke activation, 45.8% had ischemic stroke while 40.1% had stroke mimics. Stroke team response time from activation was 26 minutes for all in-hospital activations. Intravenous thrombolysis was utilized in 8% of those with ischemic stroke; 3.4% were transferred for consideration of endovascular thrombectomy. In-hospital mortality was 17.7%, and the proportion of patients discharged to home was 34.4% for all activations. Conclusion: The in-hospital stroke mortality was high, and the proportions of patients who either received or were considered for acute intervention were low. Quality improvement targeting increased use of acute stroke intervention in eligible patients and reducing hospital mortality in this patient cohort is needed.

Abstract WP455: Memorial Hermann Hospital System Stroke Coordinators: Working as One

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sandi G Shaw ◽  
Isabel Gonzales ◽  
Hari Indupuru ◽  
Nicole Harrison ◽  
Sean Savitz ◽  
...  
Keyword(s):  
Best Practice ◽  
Quality Care ◽  
High Volume ◽  
Work Load ◽  
Joint Commission ◽  
Large Hospital ◽  
Hospital System ◽  
Primary Stroke Center ◽  
Stroke Center ◽  
The Joint Commission

Background: Many hospital stroke programs fail to meet or maintain the certification requirements of The Joint Commission (TJC) as a Primary Stroke Center (PSC) or Comprehensive Stroke Center (CSC). The most common reason is the absence of a dedicated stroke program coordinator. There are opportunities for improvement to promote stroke coordinator growth and retention. Purpose: We created The Memorial Hermann Hospital System Stroke Coordinator Alliance to combine resources, reduce workload, and support stroke coordinators in order to promote adherence to best practice and maintain TJC stroke certification. Methods: The Memorial Hermann Hospital System Stroke Coordinator Alliance was developed in 2015. It includes 14 nurses who represent 11 acute care hospitals within a large hospital system in Houston (Figure1). Four of the hospitals are CSCs, five are PSCs, and two are not certified. Monthly meetings are conducted to create standardized access to resources, stroke coordinator orientation, education, medical power plans, process improvement, and data development. Coordinator work groups, a central email and shared drive, biweekly data meetings, and a buddy system were created to reduce work load, improve electronic communication, and streamline data review procedures. A partnership was created to onboard new coordinators and to prepare for mock and real time survey visits. In 2018 data abstraction was standardized across hospitals with use of a homegrown database Stroke Program Registry (REGIS). Results: Of the 14 Stroke Coordinators in place during fiscal years 2015 - 2019, retention was 100%. A total of 19 stroke surveys were completed and recognized as successful by The Joint Commission. A total of 17,148 stroke patients were received with PSC measures averaging greater than 95% and CSC measures above 90%. Conclusion: Implementing program development support for stroke coordinators improves retention and quality care in a high volume stroke system.

Choice of Initial Brain Imaging in Patients with Suspected Acute Stroke: STROKE69, a Population-Based Study

2020 ◽  
Vol 49 (1) ◽  
pp. 110-118 ◽  
Author(s):  
Yufeng Xue ◽  
Julie Haesebaert ◽  
Laurent Derex ◽  
Marie Viprey ◽  
Anne Termoz ◽  
...  
Keyword(s):  
Brain Imaging ◽  
Working Hours ◽  
Patient Characteristics ◽  
Population Based ◽  
Lower Probability ◽  
Primary Stroke Center ◽  
Magnetic Resonance Imaging Mri ◽  
Suspected Stroke ◽  
Initial Imaging ◽  
Stroke Center

Background: In patients with suspected stroke, brain imaging is recommended in the acute phase for appropriate management and treatment. Both computed tomography (CT) and magnetic resonance imaging (MRI) are considered reasonable choices for initial brain imaging. When both techniques are available, choosing one or the other might be associated with specific factors related either to patients, stroke symptoms, and severity or management organization. Methods: The study was performed within the STROKE 69 database, a population-based cohort of all adult patients with suspected stroke admitted in one of the emergency departments (ED), primary stroke center, or stroke center of the Rhône County, from November 2015 to December 2016. Patients were included if they were admitted within 24 h following either symptom onset or last known normal. To identify factors potentially associated with the choice of initial brain imaging, a multivariate logistic regression was performed. Results: Among the 3,244 patients with suspected stroke enrolled in the STROKE69 cohort, 3,107 (95.8%) underwent brain imaging within the first 24 h after admission. Among those 74.6% underwent CT as initial imaging while 25.4% had an MRI. In multivariate analyses, several factors were associated with a lower probability of having an MRI as initial brain imaging versus CT. These were either patient characteristics: older age (>80 years old, OR 0.39 [95% CI 0.28–0.54]), preexisting disability (OR 0.55 [95% CI 0.36–0.84]), use of anticoagulants (OR 0.52 [95% CI 0.33–0.81]), stroke characteristics: stroke of unknown onset (OR 0.42 [95% CI 0.31–0.58]) or factors associated with overall management: onset-to-door time (>6 h, OR 0.38 [95% CI 0.23–0.60]), initial admission to ED (OR 0.02 [95% CI 0.02–0.04]) or intensive care unit (OR 0.01 [95% CI 0.001–0.08]), personal transport (OR 0.66 [95% CI 0.45–0.96]), and admission during working hours (OR 0.65 [95% CI 0.51–0.84]). Conclusions: Besides CT or MRI availability, a number of other parameters could influence the choice of first imaging in case of stroke suspicion. These are related to patient characteristics, type of stroke symptoms, and type of organization.

Abstract TP341: Nursing Impact on the Acute Stroke Team - Driving Practice in a Collaborative Environment

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Lauri Speirs
Keyword(s):  
Emergency Department ◽  
Acute Stroke ◽  
Endovascular Therapy ◽  
Golden Hour ◽  
Stroke Team ◽  
Primary Stroke Center ◽  
Response Team ◽  
Intense Training ◽  
Stroke Center ◽  
Time Frames

Background /Purpose: In 2005 a community hospital began the journey to Primary Stroke Center. One aspect was to develop a stroke response team. The acute stroke team must provide neurologist expertise at bedside, be cost neutral, compliment the workflow in the Emergency Department, and maximize the limited number of neurologists on staff. Stroke unit nurses were identified as neurological experts in the hospital. After intense training, Stroke Alert went live in October of 2007. The nurse led acute stroke team (AST) collaborated with the medical staff to increase the total volume of stroke patients receiving t-PA. With additional training, the nurse led team assisted in the identification and transfer of patients for endovascular therapy. Method: A group of 12 nurses were trained by the stroke medical director to complete a stroke assessment, then to communicate those findings to the neurologist on call and the Emergency Department physicians. The nurse responders and the Emergency Department nurses were trained to mix and calculate the doses for t-PA. In 2010 the nurse responders were educated on the criteria for endovascular therapy, including time frames, patient assessment, and key CT results. In 2011, the nurse responders were re-educated on the golden hour of stroke. Results: Since 2008, over 450 stroke alerts have been activated each year. The administration of t-PA increased from 4 patients in 2007 to 43 patients in 2011; an additional 9 patients were sent to another facility for endovascular therapy. In the first 6 months of 2012, over 50% of patients receive t-PA in less than 60 minutes and Gold plus from the AHA was achieved. Conclusion: Nurses can be a vital asset to the AST by providing neurological expertise, collaborating with physicians, and driving the stroke protocols.

Abstract 95: The Mobile Interventional Stroke Team (MIST) Model Improves Early Outcomes in Elvo Stroke: The NYC Mist Trial

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jacob R Morey ◽  
Thomas J Oxley ◽  
Daniel Wei ◽  
Hazem Shoirah ◽  
Xiangnan Zhang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Standard Of Care ◽  
Patient Transfer ◽  
Vessel Occlusion ◽  
Delivery Of Care ◽  
Stroke Team ◽  
Primary Stroke Center ◽  
Stroke Center ◽  
Patient Presentation

Introduction: Endovascular therapy (EVT) has become the standard of care for treatment of emergent large vessel occlusion (ELVO) in ischemic stroke. It is a time sensitive procedure that has previously only been performed at comprehensive stroke centers (CSC). Transfer was required for patients presenting at a primary stroke center (PSC). PSCs with interventional capacity (PSCI) have emerged to increase access to EVT. We have developed a Mobile Interventional Stroke Team (MIST) model, in which a MIST transfers from a CSC to PSCI to perform EVT. Hypothesis: The delivery of care by the MIST at PSCIs is more time efficient and leads to improved clinical outcomes in comparison to transferring patients from a PSC to PSCI or CSC and comparable to direct presentation to a CSC. Methods: Analysis of prospectively collected data from 228 patients who received EVT for ELVO at a CSC or 4 PSCIs between June 2016 - December 2018 was performed. The cohorts include: Mothership with patient presentation to CSC (n=20), Drip-and-Ship with patient transfer from PSC or PSCI to CSC (DS) (n=114), MIST and patient presentation to PSCI (n=64), and DS with patient transfer from PSC to PSCI and MIST (DS/MIST) (n=30). The primary outcome was initial door-to-recanalization. Secondary outcomes measured other time intervals and clinical outcomes at discharge and 3 months. Results: MIST had a faster mean initial door-to-recanalization time than DS by 83 minutes (p < 0.05). MIST and Mothership had similar median times of 192 minutes and 181 minutes, respectively (p = 0.84). A greater proportion of patients reached a discharge NIHSS of 0 or 1 in MIST compared to DS (34% vs. 17%; p < 0.01). MIST led to 53% with a mRS of ≤ 2 at 3 months compared to 39% in DS, although not statistically significant (p = 0.10). Conclusions: MIST has led to significantly faster initial door-to-recanalization times compared to DS. This decrease in time has translated into improved short-term outcomes and a trend towards improved long-term outcomes.

Abstract W P362: Stroke Coordinators: Surveys from the ASA Southwest Affiliate

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Christy L Casper ◽  
Alexandra Graves ◽  
Michelle Whaley ◽  
Julie Blakie
Keyword(s):  
Best Practice ◽  
Demographic Data ◽  
Educational Preparation ◽  
Additional Information ◽  
Job Functions ◽  
Primary Stroke Center ◽  
Reporting Structure ◽  
Role Responsibilities ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: Stroke coordinators (SC) in Colorado meet monthly to share best practice and collaborate with the ASA and industry representatives. Based on informal observation, we believed that many of the coordinators were new in their roles and desired additional information and education on how to be successful. We teamed with the ASA and hosted two conferences; one for Colorado SCs and a larger conference for ASA Southwest affiliates. Demographic data was collected at both conferences. Methods: For the CO conference, surveys were sent to all SCs in the state. For the ASA conference, only those who attended were given the survey. Results were combined and content included: educational preparation, hospital volumes, certification status, reporting structure, orientation plan, role responsibilities, data expectations, and job satisfaction. Partial responses were included. Results: 94 surveys were returned. 70% were SCs for less than 2 years but 40% worked in their hospital for 1 - 5 years and 38% for >5 years. 32/41 worked at a primary stroke center (PSC) and 6/41 worked at a comprehensive stroke center. The majority (81%) were nurses (36% Diploma, 64% Bachelor’s prepared). 18% were Master’s prepared (NP, CNS, and MS in nursing but not NP or CNS). 43% either had a mentor or a structured orientation plan and exactly the same (43%) made up their orientation. 45% reported to Nursing, 40% to Quality, and few (2%) to Neurology. Respondents liked the ability to be creative and affect change at their hospital but disliked the lack of clarity in their role and the number of job functions they are expected to perform. Conclusion: SCs in the Southwest affiliate are primarily nurses with less than 2 years of experience as a SC who had worked at their hospital for at least 1 year but many for over 5 years. Most hospitals are PSCs. They equally had mentorship and training versus developing their role without much direction. SCs enjoy the ability to be creative and affect change but would like additional clarity and expectations to succeed in their roles.

scholarly journals A Computer-Based Stroke Education Orientation Program for Nurses on a Designated Stroke Unit: A Program Development, Quality Improvement Project

2017 ◽  
Author(s):  
Melanie Marco
Keyword(s):  
Stroke Unit ◽  
Stroke Patients ◽  
Orientation Program ◽  
Improvement Project ◽  
Program Manager ◽  
Stroke Team ◽  
Primary Stroke Center ◽  
Computer Based ◽  
Stroke Education ◽  
Stroke Center

<p>Evidence of improved outcomes for patients admitted to a dedicated stroke unit supports the need for specialized stroke education and protocols. The Joint Commission now requires all stroke patients be admitted to a PSC and receive care on a designated stroke unit. Care on the stroke unit is focused on preventing further debilitation, deterioration and reducing medical complications. Nurses working at a primary stroke center are required by TJC to have initial orientation stroke education and annual competency review to ensure stroke patients receive high quality, current care. The Joint Commission also requires core stroke team members receive at least eight hours of education annually, as determined by the stroke program manager. The stroke program manager determines composition of the stroke team in collaboration with hospital leadership and other stakeholders (Daniels, Johnson & Mackovjak, 2011). It is the responsibility of each primary stroke center to develop an education program for clinical staff.</p> <p>The purpose of this quality improvement project was to develop a computer-based stroke education orientation program for nurses on a recently designated stroke unit within a PSC facility.</p>

scholarly journals Mobile Interventional Stroke Team Model Improves Early Outcomes in Large Vessel Occlusion Stroke

Stroke ◽  
2020 ◽  
Vol 51 (12) ◽  
pp. 3495-3503 ◽  
Author(s):  
Jacob R. Morey ◽  
Thomas J. Oxley ◽  
Daniel Wei ◽  
Christopher P. Kellner ◽  
Neha S. Dangayach ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Endovascular Therapy ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Stroke Team ◽  
Primary Stroke Center ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Patient Presentation

Background and Purpose: Triage of patients with emergent large vessel occlusion stroke to primary stroke centers followed by transfer to comprehensive stroke centers leads to increased time to endovascular therapy. A Mobile Interventional Stroke Team (MIST) provides an alternative model by transferring a MIST to a Thrombectomy Capable Stroke Center (TSC) to perform endovascular therapy. Our aim is to determine whether the MIST model is more time-efficient and leads to improved clinical outcomes compared with standard drip-and-ship (DS) and mothership models. Methods: This is a prospective observational cohort study with 3-month follow-up between June 2016 and December 2018 at a multicenter health system, consisting of one comprehensive stroke center, 4 TSCs, and several primary stroke centers. A total of 228 of 373 patients received endovascular therapy via 1 of 4 models: mothership with patient presentation to a comprehensive stroke center, DS with patient transfer from primary stroke center or TSC to comprehensive stroke center, MIST with patient presentation to TSC and MIST transfer, or a combination of DS with patient transfer from primary stroke center to TSC and MIST. The prespecified primary end point was initial door-to-recanalization time and secondary end points measured additional time intervals and clinical outcomes at discharge and 3 months. Results: MIST had a faster mean initial door-to-recanalization time than DS by 83 minutes ( P <0.01). MIST and mothership had similar median door-to-recanalization times of 192 minutes and 179 minutes, respectively ( P =0.83). A greater proportion had a complete recovery (National Institutes of Health Stroke Scale of 0 or 1) at discharge in MIST compared with DS (37.9% versus 16.7%; P <0.01). MIST had 52.8% of patients with modified Rankin Scale of ≤2 at 3 months compared with 38.9% in DS ( P =0.10). Conclusions: MIST led to significantly faster initial door-to-recanalization times compared with DS, which was comparable to mothership. This decrease in time has translated into improved short-term outcomes and a trend towards improved long-term outcomes. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03048292.

Effect of “drip-and-ship” and “drip-and-drive” on endovascular treatment of acute ischemic stroke with large vessel occlusion: a single-center retrospective study

2021 ◽  
pp. 028418512110068
Author(s):  
Yu Hang ◽  
Zhen Yu Jia ◽  
Lin Bo Zhao ◽  
Yue Zhou Cao ◽  
Huang Huang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Primary Stroke Center ◽  
Secondary Endpoints ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background Patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) were usually transferred from a primary stroke center (PSC) to a comprehensive stroke center (CSC) for endovascular treatment (drip-and-ship [DS]), while driving the doctor from a CSC to a PSC to perform a procedure is an alternative strategy (drip-and-drive [DD]). Purpose To compare the efficacy and prognosis of the two strategies. Material and Methods From February 2017 to June 2019, 62 patients with LVO received endovascular treatment via the DS and DD models and were retrospectively analyzed from the stroke alliance based on our CSC. Primary endpoint was door-to-reperfusion (DTR) time. Secondary endpoints included puncture-to-recanalization (PTR) time, modified Thrombolysis in Cerebral Infarction (mTICI) rates at the end of the procedure, and modified Rankin Scale (mRS) at 90 days. Results Forty-one patients received the DS strategy and 21 patients received the DD strategy. The DTR time was significantly longer in the DS group compared to the DD group (315.5 ± 83.8 min vs. 248.6 ± 80.0 min; P < 0.05), and PTR time was shorter (77.2 ± 35.9 min vs. 113.7 ± 69.7 min; P = 0.033) compared with the DD group. Successful recanalization (mTICI 2b/3) was achieved in 89% (36/41) of patients in the DS group and 86% (18/21) in the DD group ( P = 1.000). Favorable functional outcomes (mRS 0–2) were observed in 49% (20/41) of patients in the DS group and 71% (15/21) in the DD group at 90 days ( P = 0.089). Conclusion Compared with the DS strategy, the DD strategy showed more effective and a trend of better clinical outcomes for AIS patients with LVO.

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