Direct to hybrid CT-angiosuite (Nexaris) reduces treatment time for stroke thrombectomy (Direct-ST): A prospective simulation study

Background Rapid thrombectomy initiation is critical for improving outcomes in acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Direct transport to an angiography suite (DTAS), bypassing standard Emergency Department CT imaging, Direct to ED CT (DTCT), reduces door-to-puncture times. This study compares standard DTCT and expedited DTAS workflows using a hybrid multidetector CT (MDCT)-angiography suite. Materials and methods This single-center, prospective, blinded analysis study simulated AIS care using a medical mannequin. Twelve simulations were conducted (six per protocol): (a) Standard DTCT and (b) Direct DTAS. Simulations included ED arrival, triage, clinical assessment, imaging, and groin puncture. All mock patients had LVO and were thrombectomy candidates (S-LAMS ≥ 4) with contraindications to lysis. Time metrics were measured and compared. Results Mean door-to-puncture time was significantly shorter in the DTAS group (DTCT: 39.83 [4.36] min vs DTAS: 22.17 [2.4] min ( P < .0001). Door-to-CT start times were similar (DTCT: 19.5 [7.15] vs DTAS: 15.0 [2.97]; P = .1848). CT-to-puncture time was shorter with DTAS (DTCT: 20.33 [5.01] vs DTAS: 7.17 [1.47]; P = .0009). CT-complete to puncture time favored DTAS (DTCT: 12.33 [3.93] vs DTAS: 2.33 [1.03]; P = .0011). Mean time from CT completion to Angio suite arrival in DTCT was 6.67 min. Conclusion A direct-to-CT-Angio (DTAS) workflow using MDCT technology significantly reduces door-to-puncture times compared to standard DTCT, improving hospital workflow for LVO stroke patients. Further clinical studies are needed.