Impact of time between thrombolysis and endovascular thrombectomy on outcomes in patients with acute ischaemic stroke.

Background

Benefits of endovascular thrombectomy (ET) after intravenous thrombolysis (IVT) for patients with acute ischaemic stroke (AIS) have been demonstrated, but analyses of the relationship between IVT-ET time delay and functional outcomes among patients receiving both treatments are lacking.

Methods

We used data from the "Berlin-Specific Acute Treatment in Ischaemic and haemorrhAgic stroke with Long-term outcome" (B-SPATIAL) registry. Between January 1st, 2016 and December 31st, 2019, we included patients who received both IVT and ET. The primary outcome was the 3-month ordinal modified Rankin scale (mRS) score. The IVT-ET time delay was analyzed in categories and continuously. We used adjusted ordinal logistic regression to estimate common odds ratios (cOR) and 95% confidence intervals (CI). Secondary analyses involved flexible modeling of IVT-ET delay and dichotomous outcomes.

Results

Of 11,049 patients, 714 who received IVT followed by ET were included. Compared with having an IVT-ET window >120 min (reference), for an IVT-ET window < 30 min, we obtained adjusted cORs for mRS of 0.41 (95% CI: 0.22 to 0.78); and 0.52 (95% CI: 0.33 to 0.82) for 30 to 120 min. Secondary analyses also found protective effects of shorter time delays against "poor" functional outcomes at 3 months.

Conclusions

In patients with AIS, shorter IVT-ET intervals were associated with better 3-month functional outcomes. While the time-to-IVT and time-to-ET include the time until medical attention is received, the IVT-ET time delays fall entirely within the domain of medical management and thus might be easier to optimize.

Informations de copyright

Copyright © 2022 Wagner, Mohrbach, Ebinger, Endres, Nolte, Harmel, Audebert, Rohmann and Siegerink.

Déclaration de conflit d'intérêts

Author JR reports receiving a grant from Novartis Pharma for a self-initiated research project on migraine remission unrelated to this work. Author MEn reports receiving grants from Bayer and fees paid to the Charité-Universitätsmedizin Berlin from AstraZeneca, Bayer, BMS, Pfizer, Daiichi Sankyo, Amgen, GSK, Sanofi, Covidien, and Novartis, outside of this work. Author CN received research grants from German Ministry of Research and Education, German Center for Neurodegenerative Diseases, German Center for Cardiovascular Research, and speaker and/or consultation fees from Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer Pharma, Daiichi Sankyo, Alexion, Abbott, and Bayer. Author HA received research grants from German Ministry of Research and Education and the German Research Foundation for the B-SPATIAL registry and the B_PROUD study and reports personal fees from Bayer Vital, Boehringer Ingelheim, Bristol- Myers Squibb, Novo Nordisk, Pfizer, and from Sanofi outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.