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SNIS 20th annual meeting electronic poster abstracts
E-247 The universal effect of the ‘golden hour’ on stroke thrombectomy outcomes
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  1. M Ash1,
  2. L Dimisko1,
  3. R Chalhoub2,
  4. B Howard1,
  5. C Cawley1,
  6. A Pabaney1,
  7. A Spiotta3,
  8. P Jabbour4,
  9. I Maier5,
  10. S Wolfe6,
  11. A Rai7,
  12. J Kim8,
  13. M Psychogios9,
  14. J Mascitelli10,
  15. R Starke11,
  16. A Shaban12,
  17. S Yoshimura13,
  18. R De Leacy14,
  19. P Kan15,
  20. I Fragata16,
  21. A Polifka17,
  22. A Arthur18,
  23. M Park19,
  24. C Matouk20,
  25. R Crosa21,
  26. R Williamson22,
  27. T Dumont23,
  28. M Levitt24,
  29. S Alkasab2,
  30. S Tjoumakaris4,
  31. J Liman5,
  32. K Fargen6,
  33. J Grossberg1,
  34. A Alawieh1
  1. 1Emory University School of Medicine, Atlanta, GA, USA
  2. 2Medical University of South Carolina, Charleston, SC, USA
  3. 3Medical University of South Carolina, Charleston, GA, USA
  4. 4Thomas Jefferson University, Philadelphia, PA, USA
  5. 5Universitätsmedizin Göttingen, Göttingen, Germany
  6. 6Wake Forest Baptist Health, Winston-Salem, NC, USA
  7. 7West Virginia University, Morgantown, WV, USA
  8. 8Chonnam National University Hospital, Kwangju, Korea, Republic of
  9. 9Universitätsspital Basel, Basel, Switzerland
  10. 10University of Texas Health Science Center, San Antonio, TX, USA
  11. 11University of Miami Health System, Miami, FL, USA
  12. 12University of Iowa, Iowa City, IA, USA
  13. 13Hyogo College of Medicine, Hyogo, Japan
  14. 14Mount Sinai Hospital, New York City, NY, USA
  15. 15University of Texas Medical Branch – Galveston, Galveston, TX, USA
  16. 16Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal, USA
  17. 17University of Florida, Gainesville, FL, USA
  18. 18The University of Tennessee Health Science Center, Memphis, TN, USA
  19. 19University of Virginia, Charlottesville, VA, USA
  20. 20Yale University, New Haven, CT, USA
  21. 21Médica Uruguaya, Montevideo, Uruguay
  22. 22Alleghany Memorial Hospital, Sparta, NC, USA
  23. 23University of Arizona, Tucson, AZ, USA
  24. 24University of Washington, Seattle, WA, USA

Abstract

Introduction Longer procedure times have been associated with poor outcomes after endovascular thrombectomy (EVT) in early randomized trials. A ‘Golden Hour’ has been used to describe worse outcomes in patients requiring more than 60 min of procedure time. Given the expanded indications for EVT recently, we performed a comprehensive evaluation of the effect of the ‘Golden Hour’ on thrombectomy outcomes in different subpopulations of EVT patients.

Methods This multicenter study included patients undergoing EVT for acute ischemic stroke at 35 centers in the US and globally between January 2013 and March 2022. Procedure time was defined as time from groin puncture to successful recanalization (a TICI score of 2B or more) or abortion of procedure. Patients were stratified based on stroke location (anterior, posterior, proximal or distal), use of IV-tPA, ASPECT score, age group, and onset-to-groin time. Clinical outcomes were assessed using the 90-day modified Rankin score with scores 0-2 designating good functional outcome. Secondary outcomes included presence of postprocedural symptomatic hemorrhage (sICH) and mortality. Logistic regression models controlling for co-variates were used to assess the adjusted odds (aOR) of good outcome per 10 min of procedure time or for different procedure time intervals.

Results Among 8961 patients included in the study, longer procedure time was associated with higher odds of poor outcome (mRS 3-6) with 10% increase in odds for each 10 min increment (aOR=1.1,p< 0.01). In procedure times that exceeded the ‘Golden Hour’ a poor outcome was twice as likely (aOR = 2, p=0.001). The ‘Golden Hour’ effect was consistent in patients with anterior and posterior circulation strokes (aOR=1.9 and 3.1 respectively), proximal or distal occlusions (aOR = 1.1 and 1.1 respectively), in patients with large core infarcts, with or without IV-tPA treatment, and across age groups. Procedures exceeding 1 hour of procedure time were associated with 40% higher incidence of sICH (aOR=1.4). When patients were stratified by age, location of stroke, ASPECT score, and administration of IV-tPA, the aOR for good outcome and sICH appear to intersect within 60 minutes of all groups studied. The cumulative rate of good outcome for each subgroup followed an exponential growth curve that plateaus around 60 min. Patient with posterior circulation stroke, those with larger core infarcts and elderly patients were most sensitive to the effect of procedure time.

Conclusions In this work we demonstrate the universality of the ‘Golden Hour’ effect, in which procedures lasting more than 1 hour are associated with worse clinical outcomes and higher rates of symptomatic hemorrhage. This study will assist clinicians in determining when to be more aggressive in their approach when aiming for TICI 3 reperfusion in different subpopulations of patients.

Disclosures M. Ash: None. L. Dimisko: None. R. Chalhoub: None. B. Howard: None. C. Cawley: None. A. Pabaney: None. A. Spiotta: None. P. Jabbour: None. I. Maier: None. S. Wolfe: None. A. Rai: None. J. Kim: None. M. Psychogios: None. J. Mascitelli: None. R. Starke: None. A. Shaban: None. S. Yoshimura: None. R. De Leacy: None. P. Kan: None. I. Fragata: None. A. Polifka: None. A. Arthur: None. M. Park: None. C. Matouk: None. R. Crosa: None. R. Williamson: None. T. Dumont: None. M. Levitt: None. S. Alkasab: None. S. Tjoumakaris: None. J. Liman: None. K. Fargen: None. J. Grossberg: None. A. Alawieh: None.

https://doi.org/10.1136/jnis-2023-SNIS.346

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