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Original research
Duration of symptomatic stroke and successful reperfusion with endovascular thrombectomy for anterior circulation large vessel occlusive stroke
  1. Adam de Havenon1,2,
  2. Matthew D Alexander2,
  3. Raul G Nogueira3,
  4. Diogo C Haussen4,
  5. Alicia C Castonguay5,
  6. Italo Linfante6,
  7. Michael Austin Johnson7,
  8. Thanh N Nguyen8,
  9. Maxim Mokin9,
  10. Osama O Zaidat10
  1. 1 Department of Neurology, University of Utah, Salt Lake City, Utah, USA
  2. 2 Department of Radiology, University of Utah, Salt Lake City, Utah, USA
  3. 3 Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
  4. 4 Neurology, Neurosurgery and Radiology, Emory University School of Medicine / Marcus Stroke & Neuroscience Center - Grady Memorial Hospital, Atlanta, Florida, USA
  5. 5 Neurology, the university of toledo medical center, Toledo, Ohio, USA
  6. 6 Baptist Cardiac and Vascular Institute, Miami, Florida, USA
  7. 7 Department of Surgery, University of Utah, Salt Lake City, Utah, USA
  8. 8 Neurology and Radiology, Boston University School of Medicine, Boston Medical Center, BOSTON, Massachusetts, USA
  9. 9 Neurosurgery, University of South Florida, Tampa, Florida, USA
  10. 10 Neuroscience, Mercy Health Saint Vincent Medical Center, Toledo, Ohio, USA
  1. Correspondence to Dr Osama O Zaidat, Neuroscience, Mercy Health Saint Vincent Medical Center, Toledo, Ohio, USA; OOZaidat{at}


Background It has been reported that longer time intervals from stroke onset to endovascular therapy are associated with lower rates of successful reperfusion in acute ischemic stroke patients with large vessel occlusion. However, procedural variables and potential mechanisms of this association have not been fully elucidated.

Methods We performed a secondary analysis of individual patient data from the North American Solitaire Stent Retriever Acute Stroke (NASA) and Trevo Stent-Retriever Acute Stroke (TRACK) registries. We included patients with occlusion of the internal carotid artery or middle cerebral artery (M1 and M2 segments) who were treated by mechanical thrombectomy within 24 hours of last known normal. The primary outcome was reperfusion, defined as a Thrombolysis In Cerebral Infarction (TICI) score ≥2b. The secondary outcome was reperfusion on the first pass. The primary predictor was duration of symptomatic stroke, defined as time from last known normal to time of final pass. Adjusted logistic regression models were utilized to determine associations between variables and outcome.

Results We included 506 patients, of which 401 (79.3%) achieved successful reperfusion (TICI 2b/3). The mean (SD) duration of symptomatic stroke was 6.8 (3.5) hours and in the adjusted logistic regression model the duration of symptomatic stroke was associated with reperfusion (OR 0.90, 95% CI 0.84 to 0.96) and reperfusion on the first pass (OR 0.89, 95% CI 0.83 to 0.95). In that model, the predicted probability of reperfusion was 88% (95% CI 0.83 to 0.92) at 1 hour, 81% (95% CI 0.78 to 0.84) at 6 hours, 70% (95% CI 0.63 to 0.77) at 12 hours, and 42% (95% CI 0.17 to 0.67) at 24 hours (ptrend=0.001). Reperfused patients were significantly younger, more likely to be male, and to have had a balloon guide catheter used during the procedure.

Conclusion In a real-world cohort of acute ischemic stroke patients with anterior circulation occlusion treated with endovascular therapy, longer duration of symptomatic stroke is associated with lower rates of successful reperfusion and reperfusion on the first pass.

  • acute ischemic stroke
  • large vessel occlusion
  • endovascular thrombectomy
  • neurologic outcome

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.

  • Contributors AD, MDA, MAJ and OOZ conceived of the methodology and authored the manuscript. Remaining authors participated in patient care and data collection. All authors edited the manuscript and reviewed the final version.

  • Funding This work was supported by NIH-NINDS grant number K23NS105924. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Competing interests AD reports investigator initiated funding from AMAG and Regeneron pharmaceuticals. RGN reports consulting fees for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Imperative Care, Medtronic, Phenox, Prolong Pharmaceuticals, Stryker Neurovascular and stock options for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, and Perfuze. TN is Principal Investigator of the CLEAR study funded by Medtronic; serves on the Data Safety Monitoring Board for TESLA (Thrombectomy for Emergent Salvage of Large Anterior Circulation Ischemic Stroke), ENDOLOW (Endovascular Therapy for Low NIHSS Ischemic Strokes), and SELECT 2 (A Randomized Controlled Trial to Optimize Patient’s Selection for Endovascular Treatment in Acute Ischemic Stroke) trials.

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