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  • Longer procedural times are independently associated with symptomatic intracranial hemorrhage in patients with large vessel occlusion stroke undergoing thrombectomy

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Ischemic stroke
Original research
Longer procedural times are independently associated with symptomatic intracranial hemorrhage in patients with large vessel occlusion stroke undergoing thrombectomy
  1. Tareq Kass-Hout1,
  2. Omar Kass-Hout1,2,
  3. Chung-Huan Johnny Sun1,3,
  4. Taha A Kass-Hout4,5,
  5. Raul Nogueira1,
  6. Rishi Gupta1,6
  1. 1Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
  2. 2Catholic Health system, Department of Neuroscience, Buffalo, New York, USA
  3. 3Columbia University, Department of Neurology New York, New York, USA
  4. 4Humanitarian Tracker, Washington DC, USA
  5. 5Rochester Regional Health System, Department of Neuroscience, Rochester, New York, USA
  6. 6Department of Wellstar Neurosurgery, Kennestone Hospital, Marietta, Georgia, USA
  1. Correspondence to Dr Rishi Gupta, Department of Wellstar Neurosurgery, Kennestone Hospital, 61 Whitcher Street, Suite 3110, Marietta, GA 30060, USA; Guptar31{at}gmail.com

Abstract

Background Time to reperfusion is an essential factor in determination of outcomes in acute ischemic stroke (AIS).

Objective To establish the effect of the procedural time on the clinical outcomes of patients with AIS.

Methods Data from all consecutive patients who underwent mechanical thrombectomy between September 2010 and July 2012 were analysed retrospectively. The variable of interest was procedural time (defined as time from groin puncture to final recanalization time). Outcome measures included the rates of symptomatic intracranial hemorrhage (sICH, defined as any parenchymal hematoma—eg, PH-1/PH-2), final infarct volume, 90-day mortality, and independent functional outcomes (modified Rankin Scale 0–2) at 90 days.

Results The cohort included 242 patients with a mean age of 65.5±14.2 and median baseline National Institutes of Health Stroke Scale score 20. 51% of the patients were female. The mean procedure time was significantly shorter in patients with a good outcome (86.7 vs 73.1 min, respectively, p=0.0228). Patients with SICH had significantly higher mean procedure time than patients without SICH (79.67 vs 104.5 min, respectively; p=0.0319), which remained significant when controlling for the previous factors (OR=0.974, 95% CI 0.957 to 0.991). No correlation was found between the volume of infarction and the procedure time (r=0.10996, p=0.0984). No association was seen between procedure time and 90-day mortality (77.8 vs 88.2 min in survivals vs deaths, respectively; p=0.0958).

Conclusions Our data support an association between the risk of SICH and a longer procedure time, but no association between procedural times and the final infarction volume or long-term functional outcomes was found.

  • Stroke
  • Stent
  • Hemorrhage
  • Thrombectomy

https://doi.org/10.1136/neurintsurg-2015-012157

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    Footnotes

    • Twitter Follow Taha Kass-Hout at @kasshout

    • Contributors Conceived and designed the research: RN, RG. Acquired the data: C-HJS, TK-H. Analyzed and interpreted the data; performed the statistical analysis: C-HJS, TK-H, TAK-H, OK-H. Handled funding and supervision: RN, RG. Drafted the manuscript: TK-H, RN, RG. Made critical revision of the manuscript for important intellectual content: all authors.

    • Competing interests RN: Stryker Neurovascular (Trevo-2 and DAWN Trials principal instigator); Covidien (SWIFT and SWIFT Prime Trials Steering Committee; STAR Trial Angiographic Core Laboratory), Penumbra (3D Separator Trial Executive Committee), Rapid Medical (Stroke Trial Data Safety Monitoring Board). RG: consultant: Stryker Neurovascular, Covidien, Rapid Medical; Steering Committee for Penumbra THERAPY trial; associate editor Journal of Neuroimaging; associate editor Interventional Neurology; royalties from UpToDate.

    • Provenance and peer review Not commissioned; externally peer reviewed.