One of the factors responsible for overall improvement of the acute stroke care is improvement of door to CT (DTCT) and door to needle (DTN) times. The current AHA guideline recommends door to CT time (DTCT) of less than 25 minutes and door to needle (DTN) times of less than 60 minutes.



This study is a single center experience  (MGH), which evaluates these parameters for the patients who presented directly with acute ischemic stroke 2003 – 2006 compared with 2008 – 2011 periods. In 2007, MGH developed a new acute stroke protocol with ten best practices to lower DTCT and DTN times; all of which were later incorporated into the Target Stroke Initiative launched by the AHA and ASA. DTCT and DTN times improved dramatically after applying ten best practices established by NINDS and stroke expert community.

Out of 4,477 patients with acute stroke, 2,595 was evaluated, ~60% pre and ~40% post 2007 changes. Median DTCT time was 68 minutes (71 pre intervention compared with 59 post intervention) but for the patients receiving rt-PA, it was 24 minutes (30 pre vs 18 post intervention) with DTN time 58 minutes (70 pre vs 47 post intervention). Target DTCT </= 25 doubled from 37.5% to 75.4% and DTN </=60 increased from 32.1% to 70.3%.
These results speak for themselves. Decreasing the times was not easy to achieve, but well-oiled teams are able to achieve well-defined targets and continue to push the envelope and improve acute stroke care and set an example and goals for the rest of the stroke community. This is a single, tertiary care center experience and as such has important limitation, but still, this is very inspiring and moving data. Makes you want to push yourself further.