Introduction: Randomized controlled trials have demonstrated the importance of time-to-treatment on clinical outcomes in large vessel occlusion (LVO) stroke. Delays in interventional radiology (INR) consultation are associated with a significant delay in overall time to endovascular treatment (EVT). Delays in EVT are particularly prevalent in Primary Stroke Centers (PSC), hospitals without thrombectomy capability onsite, where the patient requires transfer to a Thrombectomy Capable or Comprehensive Stroke Center for EVT. A novel computer aided triage system, Viz LVO, assists in early notification of the PSC stroke team and affiliated INR team. This platform includes an image viewer, communication system, and an artificial intelligence algorithm that automatically identifies suspected LVO strokes on CTA imaging and rapidly triggers alerts. Hypothesis: Viz LVO will decrease time-to-treatment and improve clinical outcomes. Methods: A prospectively maintained database was assessed for all patients who presented to a PSC currently utilizing Viz LVO in the Mount Sinai Health System in New York and underwent EVT following transfer for LVO stroke between October 1, 2018 and March 15, 2020. There were 42 patients who fit the inclusion criteria and divided into pre- and post-Viz ContaCT implementation by comparing the periods of October 1, 2018, to March 15, 2019 (Pre-Viz) and October 1, 2019, to March 15, 2020, (Post-Viz). Time intervals and clinical outcomes were collected and compared. Results: The Pre- and Post-Viz cohorts were similar in terms of gender, age, proportion receiving IV-tPA, and proportion with revascularization of TICI > 2B. The presenting NIHSS and pre-stroke mRS scores were not statistically different. The median initial door-to-INR notification was significantly faster in the post-Viz cohort (21.5 minutes vs 36 minutes; p=0.02). The median initial door-to-puncture time interval was 20 minutes shorter in the Post-Viz cohort, but this was not statistically significant (p=0.20). The 5-day NIHSS and discharge mRS were both significantly lower in the Post-Viz cohort (p=0.02 and p=0.03, respectively). The median 90-day mRS scores were also significantly lower post-Viz implementation, although a similar proportion received a good outcome (mRS score less than or equal to 2) (p=0.02 and p=0.42, respectively). Conclusions: EVT is a time-sensitive intervention that is only available at select stroke centers. Significant delays in time-to-treatment are present when patients require transfer from PSCs to a EVT capable stroke center. In a large health care system, we have shown that Viz LVO implementation is associated with improved time to INR notification and clinical outcomes. Viz LVO has the potential for wide-spread improvement in clinical outcomes with implementation across large hub and stroke systems across the country.

中文翻译：

---

Viz LVO对就诊于初级卒中中心的大血管阻塞性卒中患者的治疗时间和临床结果的影响

简介：随机对照试验证明了大血管阻塞（LVO）脑卒中治疗时间对临床结果的重要性。介入放射学（INR）咨询的延迟与到血管内治疗（EVT）的总体时间的显着延迟有关。EVT的延迟在原发性卒中中心（PSC），现场没有血栓切除术能力的医院中尤其普遍，患者需要转移到有血栓切除术能力或EVT综合卒中中心。新型的计算机辅助分类系统Viz LVO可帮助PSC中风团队和相关的INR团队尽早通知。该平台包括图像查看器，通信系统和人工智能算法，该算法可自动识别CTA成像上的可疑LVO笔画并迅速触发警报。假设：Viz LVO将减少治疗时间并改善临床结果。方法：对前瞻性维护的数据库进行了评估，评估了所有在纽约Mount Sinai Health System中当前使用Viz LVO的PSC患者，并于2018年10月1日至2020年3月15日转移LVO中风后行了EVT。通过比较2018年10月1日至2019年3月15日（Pre-Viz）和2019年10月1日至2020年3月15日的时间段，符合纳入标准并划分为Viz实施前后的42位患者， （后维兹）。收集时间间隔和临床结果并进行比较。结果：在维兹之前和之后的队列在性别，年龄，接受IV-tPA的比例以及TICI> 2B的血运重建方面均相似。目前的NIHSS和卒中前mRS评分在统计学上没有差异。在Viz后队列中，初始门到INR通知的中位数明显更快（21.5分钟vs 36分钟； p = 0.02）。在维兹病后队列中，初始门到穿刺时间间隔的中位数短了20分钟，但这在统计学上并不显着（p = 0.20）。在维兹病后队列中，5天NIHSS和出院mRS均显着降低（分别为p = 0.02和p = 0.03）。90天的mRS得分中值也明显低于Viz实施后，尽管相似的比例获得了良好的预后（mRS得分小于或等于2）（分别为p = 0.02和p = 0.42）。结论：EVT是一种对时间敏感的干预措施，仅在特定的卒中中心可用。当患者需要从PSC转移到具有EVT功能的中风中心时，治疗时间就会显着延迟。在大型的医疗保健系统中，我们已经证明Viz LVO的实施与INR通知时间和临床结果的改善有关。通过在全国范围内的大型枢纽和中风系统中实施，Viz LVO具有广泛改善临床疗效的潜力。