Journal article
Association of Component Strategies of the Target Stroke Phase 3 Nationwide Quality Improvement Program With Accelerated Door-to-Puncture and Door-In-Door-Out Times for Ischemic Stroke Endovascular Thrombectomy in the United States
Circulation Cardiovascular quality and outcomes, Vol.18(11), e012456
11/2025
DOI: 10.1161/CIRCOUTCOMES.125.012456
PMCID: PMC12616356
PMID: 41111412
Abstract
The Target Stroke Phase III program is a national quality improvement initiative led by the American Heart Association, which sought to improve the quality of care for patients with acute stroke undergoing acute reperfusion therapy including endovascular thrombectomy (EVT).
A retrospective, observational cohort study was performed using data from the American Heart Association Get With The Guidelines-Stroke Program between January 1, 2017, and March 31, 2022. Three categories of patients were analyzed: (1) patients who arrived directly at the thrombectomy hospital and had EVT, (2) patients who were transferred in from a nonthrombectomy hospital and had EVT, and (3) patients at a nonthrombectomy hospital who were potentially eligible for EVT, received intravenous thrombolysis, and were transferred out. The primary end point of this study for thrombectomy hospitals was door-to-puncture time.
In direct-arriving EVT patients, 2 Target Stroke Phase III strategies were independently associated with shorter door-to-puncture time: (1) alerting the neurointerventional team based on emergency medical services prenotification (-21.9 [95% CI, -42.5 to -1.3] minutes) and (2) performance of a brain computed tomography and computed tomography angiography in all patients presenting ≤24 hours from time last known well (-6.6 [95% CI, -11.8 to -1.5] minutes). In transfer-in EVT patients, 2 Target Stroke Phase III strategies were independently associated with a shorter door-to-puncture time: (1) increased use of stroke screening tools (-3.5 [95% CI, -6.4 to -0.6] minutes per 25% increase in use of the screening tool) and (2) increased use of a camera during telestroke consultations (-5.8 [95% CI, -10.7 to -0.9] minutes per 25% increase in camera use).
Several Target Stroke Phase III strategies are associated with more timely care, which are distinctly different for thrombectomy and nonthrombectomy hospitals and for patients arriving by emergency medical services compared with interfacility transfer.
Details
- Title: Subtitle
- Association of Component Strategies of the Target Stroke Phase 3 Nationwide Quality Improvement Program With Accelerated Door-to-Puncture and Door-In-Door-Out Times for Ischemic Stroke Endovascular Thrombectomy in the United States
- Creators
- Brian Mac Grory - Duke UniversityKaiz S Asif - University of Illinois Urbana-ChampaignHaolin Xu - Duke UniversityBrooke Alhanti - Duke UniversityJay Lusk - University of North Carolina at Chapel HillDavid Hasan - Duke UniversitySoojin Park - Columbia UniversityAmelia K Boehme - Columbia UniversityKori S Zachrison - Massachusetts General HospitalMayank Goyal - University of CalgaryAndrew M Southerland - University of VirginiaAshutosh Jadhav - Barrow Neurological InstituteSantiago Ortega Gutierrez - Departments of Neurology and Neurosurgery, University of Iowa (S.O.G.)Ameer Hassan - The University of Texas Rio Grande ValleyKyle Fargen - Wake Forest UniversityKevin N Sheth - Yale UniversityEdward C Jauch - Mountain Area Health Education CenterYing Xian - The University of Texas Southwestern Medical CenterEric D Peterson - The University of Texas Southwestern Medical CenterEric E Smith - University of CalgarySteven R Messe - University of PennsylvaniaLee H Schwamm - Yale UniversityPeter Panagos - Washington University in St. LouisCharles Wira - Yale UniversityJeffrey L Saver - University of California, Los AngelesGregg C Fonarow - University of California, Los Angeles
- Resource Type
- Journal article
- Publication Details
- Circulation Cardiovascular quality and outcomes, Vol.18(11), e012456
- DOI
- 10.1161/CIRCOUTCOMES.125.012456
- PMID
- 41111412
- PMCID
- PMC12616356
- NLM abbreviation
- Circ Cardiovasc Qual Outcomes
- ISSN
- 1941-7705
- eISSN
- 1941-7705
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS; PHILADELPHIA
- Grant note
- American Heart AssociationAmerican Stroke AssociationNovartisNovo NordiskAstraZeneca Rare DiseaseDaiichi SankyoGenentechJanssenMoore Foundation
The Get With The Guidelines-Stroke (GWTG-Stroke) program is provided by the American Heart Association and the American Stroke Association. GWTG-Stroke is sponsored, in part, by Novartis, Novo Nordisk, AstraZeneca, Bayer, Tylenol, Alexion, and AstraZeneca Rare Disease. This study is supported by the Addressing Real-World Anticoagulant Management Issues in Stroke registry, which is sponsored by Daiichi Sankyo, Genentech, and Janssen. Additional funding was also provided by the Moore Foundation. The funders/sponsors had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data, and preparation, review, or approval of the manuscript and decision to submit the manuscript for publication.
- Language
- English
- Electronic publication date
- 10/20/2025
- Date published
- 11/2025
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9985016010802771
Metrics
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