PT - JOURNAL ARTICLE AU - Requena, Manuel AU - Ren, Zeguang AU - Ribo, Marc TI - Direct Transfer to Angiosuite in Acute Stroke AID - 10.1212/WNL.0000000000012799 DP - 2021 Nov 16 TA - Neurology PG - S34--S41 VI - 97 IP - 20 Supplement 2 4099 - http://n.neurology.org/content/97/20_Supplement_2/S34.short 4100 - http://n.neurology.org/content/97/20_Supplement_2/S34.full SO - Neurology2021 Nov 16; 97 AB - Time to reperfusion is one of the strongest predictors of functional outcome in acute stroke due to a large vessel occlusion (LVO). Direct transfer to angiography suite (DTAS) protocols have shown encouraging results in reducing in-hospital delays. DTAS allows bypassing of conventional imaging in the emergency room by ruling out an intracranial hemorrhage or a large established infarct with imaging performed before transfer to the thrombectomy-capable center in the angiography suite using flat-panel CT (FP-CT). The rate of patients with stroke code primarily admitted to a comprehensive stroke center with a large ischemic established lesion is <10% within 6 hours from onset and remains <20% among patients with LVO or transferred from a primary stroke center. At the same time, stroke severity is an acceptable predictor of LVO. Therefore, ideal DTAS candidates are patients admitted in the early window with severe symptoms. The main difference between protocols adopted in different centers is the inclusion of FP-CT angiography to confirm an LVO before femoral puncture. While some centers advocate for FP-CT angiography, others favor additional time saving by directly assessing the presence of LVO with an angiogram. The latter, however, leads to unnecessary arterial punctures in patients with no LVO (3%–22% depending on selection criteria). Independently of these different imaging protocols, DTAS has been shown to be effective and safe in improving in-hospital workflow, achieving a reduction of door-to-puncture time as low as 16 minutes without safety concerns. The impact of DTAS on long-term functional outcomes varies between published studies, and randomized controlled trials are warranted to examine the benefit of DTAS.ANGIOCAT=Evaluation of Direct Transfer to Angiography Suite vs. Computed Tomography Suite in Endovascular Treatment: Randomized Clinical Trial; ASPECTS=Alberta Stroke Program Early CT Score; CI=confidence interval; CTA=CT angiography; CTP=CT perfusion; DIRECT-MT=Direct Intra-Arterial Thrombectomy in Order to Revascularize AIS Patients With Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals; DTAS=direct transfer to angiography suite; DTP=door arrival to femoral puncture; EVT=endovascular treatment; FP-CT=flat-panel CT; HERMES=Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke; LVO=large vessel occlusion; MR CLEAN=Multicenter Randomized Clinical Trial of Endovascular Treatment for AIS in the Netherlands; mRS=modified Rankin Scale; MT=mechanical thrombectomy; MVO=medium vessel occlusion; NIHSS=NIH Stroke Scale; OR=odds ratio; OTD=onset to door arrival; RCT=randomized controlled trial; THRACE=Trial and Cost Effectiveness Evaluation of Intra-Arterial Thrombectomy in Acute Ischemic Stroke; tPA=tissue plasminogen activator