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Complete reperfusion mitigates influence of treatment time on outcomes after acute stroke
  1. Shyam Prabhakaran1,
  2. Alicia C Castonguay2,
  3. Rishi Gupta3,
  4. Chung-Huan J Sun4,
  5. Coleman O Martin5,
  6. William Holloway5,
  7. Nils H Mueller-Kronast6,
  8. Joey English7,
  9. Italo Linfante8,
  10. Guilherme Dabus8,
  11. Tim Malisch9,
  12. Franklin Marden9,
  13. Hormozd Bozorgchami10,
  14. Andrew Xavier11,
  15. Ansaar Rai12,
  16. Michael Froehler12,13,
  17. Aamir Badruddin14,
  18. Mohammad Asif Taqi15,
  19. Roberta Novakovic16,
  20. Michael Abraham17,
  21. Vallabh Janardhan18,
  22. Hashem Shaltoni19,
  23. Albert J Yoo18,
  24. Alex Abou-Chebl18,
  25. Peng Chen19,
  26. Gavin Britz20,
  27. Ritesh Kaushal21,
  28. Ashish Nanda22,
  29. Raul Nogueira4,
  30. Thanh Nguyen23,
  31. Osama O Zaidat24
  1. 1Northwestern University, Chicago, Illinois, USA
  2. 2University of Texas, MD Anderson, Houston, Texas, USA
  3. 3Wellstar Neurosurgery Kennestone Hospital, Atlanta, Georgia, USA
  4. 4Emory University School of Medicine, Atlanta, Georgia, USA
  5. 5Saint Luke's Kansas City, Kansas City, Missouri, USA
  6. 6Delray Medical Center, Delray Beach, Florida, USA
  7. 7California Pacific Medical Center, San Francisco, California, USA
  8. 8Baptist Cardiac and Vascular Institute, Miami, Florida, USA
  9. 9Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
  10. 10Oregon Health and Science University, Portland, Oregon, USA
  11. 11Wayne State University School of Medicine, Detroit, Michigan, USA
  12. 12West Virginia University Hospital, Morgantown, West Virginia, USA
  13. 13Vanderbilt University Medical Center, Nashville, Tennessee, USA
  14. 14Provena Saint Joseph Medical Center, Joliet, Illinois, USA
  15. 15Desert Regional Medical Center, Palm Springs, California, USA
  16. 16University of Texas Southwestern Medical Center, USA
  17. 17University of Kansas Medical Center, Kansas City, Kansas, USA
  18. 18Texas Stroke Institute, Plano, Texas, USA
  19. 19University of Texas Health Science Center, Houston, Texas, USA
  20. 20Methodist Neurological Institute, Houston, Texas, USA
  21. 21Saint Louis University, St Louis, Missouri, USA
  22. 22University of Missouri, Columbia, Missouri, USA
  23. 23Boston Medical Center, Boston, Massachusetts, USA
  24. 24St Vincent Mercy Medical Center, Toledo, Ohio, USA
  1. Correspondence to Dr Shyam Prabhakaran, Northwestern University, 710 N Lake Shore Drive 1422, Chicago, IL 60640, USA; shyam.prabhakaran{at}


Background Time to reperfusion following endovascular treatment (ET) predicts outcomes after acute ischemic stroke (AIS).

Objective To assess the time–outcome relationship within reperfusion grades in the North American Solitaire Acute Stroke registry.

Methods We identified patients given ET for anterior circulation ischemic stroke within 8 h from onset and in whom reperfusion was achieved. Together with clinical and outcome data, site-adjudicated modified Thrombolysis in Cerebral Ischemia (TICI) was recorded. We assessed the impact of time to reperfusion (onset to procedure completion time) on good outcome (modified Rankin Scale 0–2 at 3 months) in patients who achieved TICI 2 or higher reperfusion in multivariable models. We further assessed this relationship within strata of reperfusion grades. A p<0.05 was considered significant.

Results Independent predictors of good outcome at 3 months among those achieving TICI ≥2a reperfusion (n=188) were initial National Institutes of Health Stroke Scale score (adjusted OR=0.90, 95% CI 0.85 to 0.95), symptomatic hemorrhage (adj. OR=0.16, 95% CI 0.05 to 0.60), TICI grade (TICI 3: adj. OR=11.52, 95% CI 3.34 to 39.77; TICI 2b: adj. OR=5.14, 95% CI 1.61 to 16.39), and time to reperfusion per 30 min interval (adj. OR=0.91, 95% CI 0.82 to 0.99). There was an interaction between final TICI grade and 30 min time to reperfusion intervals (p=0.001) such that the effect of time was strongest in TICI 2a patients.

Conclusions Time to reperfusion was a strong predictor of outcome following ET for AIS. However, the effect varied by TICI grade such that its greatest effect was in those achieving TICI 2a reperfusion.

  • Thrombectomy
  • Stroke
  • Device

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