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Original research
Effect of time from onset to endovascular therapy on outcomes: the National Acute Stroke Israeli (NASIS)-REVASC registry
  1. Shlomi Peretz1,
  2. Guy Raphaeli2,
  3. Natan Borenstein3,
  4. Ronen R Leker4,
  5. Ran Brauner1,
  6. Anat Horev5,
  7. José E Cohen6,
  8. Gregory Telman7,
  9. Hen Halevi3,
  10. David Tanne8
  1. 1 Department of Neurology, Rabin Medical Center, Petah Tikva, Israel
  2. 2 Neurology and Interventional Neuroradiology Unit, Rabin Medical Center, Petach Tikva, Israel
  3. 3 Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  4. 4 Department of Neurology, Hadassah-Hebrew Univ Med Ctr, Jerusalem, Israel
  5. 5 Department of Neurology, Soroka University Medical Center, Beer Sheva, Southern, Israel
  6. 6 Neurosurgery and Radiology, Hadassah-Hebrew Univ Med Ctr, Jerusalem, Israel
  7. 7 Department of Neurology, Rambam Health Care Campus, Haifa, Haifa, Israel
  8. 8 Department of Neurology, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
  1. Correspondence to Dr. Shlomi Peretz, Rabin Medical Center, Petah Tikva 49100, Israel; shlomipe{at}


Background Endovascular therapy (EVT) is currently the most effective treatment for emergent large vessel occlusion (ELVO) stroke. Earlier treatment is associated with a better clinical outcome. Our aim was to examine the association between onset-to-EVT (OTE) time and clinical outcomes using real-world nationwide data from the National Acute Stroke ISraeli (NASIS)-REVASC registry.

Methods Stroke patients undergoing EVT within the Endovascular Capable Centres (ECCs) in Israel between January 2014 and March 2016 were prospectively included. Several clinical and radiological outcomes were evaluated. The association between OTE time and outcomes was analyzed with logistic regression models using time as a continuous variable and then by OTE groups of <2, 2–4, 4–6, and >6 hours.

Results 299 patients with acute stroke were included in the analysis. OTE time was significantly associated with favorable outcomes. ORs for each hour of delay in EVT were 0.84 (95% CI 0.71 to 0.99) for significant early recovery, 0.80 (95% CI 0.68 to 0.94) for discharge to home, 0.80 (95% CI 0.66 to 0.95) for freedom from disability at discharge, and 0.78 (95% CI 0.67 to 0.91) for excellent reperfusion (Thrombolysis in Cerebral Ischemia 3). The <2 OTE group was significantly associated with better outcomes than the ≥2 OTE group including significant early recovery (OR 3.3, 95% CI 1.2 to 9.1), discharge to home (OR 3.32, 95% CI 1.3 to 8.5), and excellent reperfusion (OR 4.6, 95% CI 1.3 to 29.5). The same trend was observed for freedom from disability at discharge and 3 months (OR 2.08, 95% CI 0.7 to 5.7 and OR 2.57, 95% CI 0.8 to 8.3, respectively). Only 1% of transferred patients achieved an OTE time of <2 hours.

Conclusions Nationwide real-life registry data indicate that benefit from EVT is strongly associated with OTE time and is most prominent within the ‘two golden hours’ from stroke onset. This time goal may not be applicable in inter-hospital transfer patients.

  • endovascular therapy
  • national stroke registry
  • real-world data
  • onset-to-puncture time
  • interhospital transfer

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  • Contributors SP is the guarantor, NB, RRL, and DT researched the literature and conceived the study. HH was involved in data analysis. RB wrote the draft of the manuscript. GR, AH, and JEC were involved in protocol development and patient recruitment. All authors reviewed and edited the manuscript and approved the final version.

  • Funding The NASIS-REVASC registry was supported by unrestricted grants from Stryker and Medtronic.

  • Competing interests None declared.

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

  • Patient consent for publication Not required.