Impact of procedural time on clinical and angiographic outcomes in patients with acute ischemic stroke receiving endovascular treatment.

BACKGROUND

Procedural time in patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy may affect clinical outcomes. We performed a pooled analysis of the effect of procedural time on clinical outcomes using data from three prospective endovascular treatment trials.

OBJECTIVE

To examine the relationship between endovascular procedural time and clinical outcomes of patients with AIS following endovascular treatment.

METHODS

We analyzed data from SWIFT, STAR, and SWIFT PRIME studies, including baseline characteristics: National Institutes of Health Stroke Scale (NIHSS) score on admission, intracranial hemorrhage rates, and modified Rankin Scale score at 3 months. The Thrombolysis in Cerebral Infarction (TICI) scale was used to grade postprocedure recanalization. We recorded two procedural time intervals: (1) symptom onset to groin puncture and (2) groin puncture to angiographic recanalization. A multivariate analysis was performed using a logistic regression model to analyze predictors of unfavorable outcome.

RESULTS

We analyzed 301 patients who had undergone endovascular treatment and had near-complete or complete recanalization (TICI 2b or 3). At 3 months, 122 patients (40.5%) had unfavorable outcomes. The rate of favorable outcomes was significantly higher when the procedural time was <60 min compared with ≥60 min (62% vs 45%, p=0.020). Predictors of unfavorable outcome at 3 months were age (unit 10 years, OR=0.62, 95% CI 0.46 to 0.82, p<0.001), onset to groin puncture time (unit hour, OR=0.61, 95% CI 0.48 to 0.77, p<0.001), groin puncture to recanalization (unit 10 min, OR=0.89, 95% CI 0.80 to 0.99, p=0.032), baseline NIHSS score (20-28 vs 8-10, OR=0.17, 95% CI 0.05 to 0.62, p=0.018), and collaterals (OR=1.48, 95% CI 1.04 to 2.10, p=0.029).

CONCLUSION

Procedural time in patients with stroke undergoing mechanical thrombectomy may be an important determinant of favorable outcomes in those with recanalization.

Informations de copyright

© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

Déclaration de conflit d'intérêts

Competing interests: AEH serves as a Consultant, Proctor and Advisor and has received honoraria from Medtronic, Stryker, Penumbra, GE Healthcare, Genentech, and Microvention. JLS is an employee of the University of California, which holds a patent on retriever devices for stroke. DL has received an NIH grant and serves as a scientific consultant to Stryker and Medtronic. MG serves as consultant for Medtronic Neurovascular and as co-principal investigator for ESCAPE and SWIFT PRIME trials. The Regents of the University of California receives funding for RJ’s services as a scientific consultant regarding trial design and conduct to Medtronic/Covidien, and RJ is an employee of the University of California, which holds a patent on retriever devices for stroke. AQ has received grant support from Boston Scientific, Cordis Therapeutics, Cor Therapeutics, Centocor therapeutics, C R Bard, and San Francisco Science/PICS. He has also received consultant fees from EndoTex Interventional Systems and Boston Scientific and an honorarium from Boehringer Ingelheim.