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Ischemic Stroke
Original research
Impact of procedural time on clinical and angiographic outcomes in patients with acute ischemic stroke receiving endovascular treatment
  1. Ameer E Hassan1,2,3,
  2. Umar Shariff2,
  3. Jeffrey L Saver4,
  4. Mayank Goyal5,
  5. David Liebeskind6,
  6. Reza Jahan7,
  7. Adnan I Qureshi8
  1. 1 Department of Neurology and Radiology, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
  2. 2 Department of Clinical Neuroscience Research, Valley Baptist Medical Center, San Antonio, Texas, USA
  3. 3 Neurology, University of Texas Rio Grande Valley, Harlingen, TX, USA
  4. 4 Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
  5. 5 Department of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
  6. 6 Neurovascular Imaging Research Core, UCLA, Los Angeles, California, USA
  7. 7 Department of Interventional Neuroradiology, UCLA Medical Center, Los Angeles, California, USA
  8. 8 Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota, USA
  1. Correspondence to Dr Ameer E Hassan, Department of Neurology,University of Texas Rio Grande Valley Harlingen TX 78550 USA ; ameerehassan{at}gmail.com

Abstract

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.

  • thrombectomy
  • stroke

https://doi.org/10.1136/neurintsurg-2018-014576

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    Footnotes

    • Contributors All authors made substantial contributions to conception and design, analysis, and interpretation of data; drafted or critically revised the article; and gave final approval of the version to be published.

    • Funding This work was supported by Medtronic, Inc.

    • 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.

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

    • Patient consent for publication Not required.