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Ischemic stroke
Original research
Impact of off-hour endovascular therapy on outcomes for acute ischemic stroke: insights from STAR
  1. Christine Tschoe1,
  2. Carol Kittel1,
  3. Patrick Brown1,
  4. Muhammad Hafeez2,
  5. Peter Kan3,
  6. Ali Alawieh4,
  7. Alejandro M Spiotta4,
  8. Eyad Almallouhi5,
  9. Travis M Dumont6,
  10. David J McCarthy7,
  11. Robert M Starke7,
  12. Reade De Leacy8,
  13. Stacey Q Wolfe1,
  14. Kyle M Fargen1
  1. 1Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  2. 2Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
  3. 3Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
  4. 4Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
  5. 5Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
  6. 6Department of Surgery, Division of Neurosurgery, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA
  7. 7Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
  8. 8Radiology, Mount Sinai Health System, New York, New York, USA
  1. Correspondence to Dr Christine Tschoe, Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA; ctschoe{at}gmail.com

Abstract

Background The off-hour effect has been observed in the medical care of acute ischemic stroke. However, it remains unclear if time of arrival affects revascularization rates and outcomes after endovascular therapy (EVT) for emergent large vessel occlusion (ELVO). We aimed to investigate the clinical outcomes of EVT between on-hour and off-hour admissions.

Methods Patients who underwent EVT for ELVO from January 2013 to June 2019 from the STAR Registry were included. Patients were grouped based on time of groin puncture: on-hour period (Monday through Friday, 7:00 am–4:59 pm) and off-hour period (overnight 5:00pm–6:59am and the weekends). Primary outcome was final modified Rankin Scale (mRS) at 90 days on mRS-shift analysis.

Results A total of 1919 patients were included in the study from six centers. The majority of patients (1169, 60.9%) of patients presented during the off-hour period. The mean age was 68.1 years and 50.5% were women. Successful reperfusion, as defined by a Thrombolysis In Cerebral Infarction (TICI) score of ≥2B, was achieved in 88.8% in the on-hour group and 88.0% in the off-hour group. Good clinical outcome (mRS 0–2) was obtained in 34.4% of off-hour patients and 37.7% of on-hour patients. On multivariable ordinal logistic regression analysis, time of presentation was not associated with worsened outcome (OR 1.150; 95% CI 0.96 to 1.37; P=0.122). Age, admission National Institutes of Health Stroke Scale (NIHSS), baseline mRS, and final TICI score were significantly associated with worse outcomes.

Conclusion There is no statistical difference in functional outcome in acute ischemic stroke patients who underwent EVT during on-hours versus off-hours.

  • stroke
  • thrombectomy
  • intervention

https://doi.org/10.1136/neurintsurg-2020-016474

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    Footnotes

    • Collaborators On behalf of the Stroke Thrombectomy and Aneurysm Registry (STAR) Collaborators: Christine Tschoe, MD (1); Carol Kittel, MA, (2); Patrick Brown, MD,(1,3); Anthony Anzalone, MS (1); Colton Smith, BA (1); Trent VanHorn, BA (1); Muhammad Hafeez, MD (4); Peter Kan, MD (4); Ali Alawieh, MD (5); Sami Al Kasab, MD (5); Jonathan Lena, MD (5); Kimberly Kicielinski, MD (5); Alejandro M Spiotta, MD (5); Eyad Almallouhi, MD (6); Travis M Dumont, MD (7); David J McCarthy, MSc (8); Robert M Starke, MD (8); Christopher Kellner, MD (9) Johanna Fifi, MD (9); Reade De Leacy, MD (9); Stacey Q Wolfe, MD (1); Kyle M Fargen, MD (1). Institutions: (1) Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA; (2) Division of Public Health Sciences, Department of Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA; (3) Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA; (4) Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA; (5) Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA; (6) Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA; (7) Department of Neurosurgery, University of Arizona, Tucson, Arizona, USA; (8) Department of Neurological Surgery and Neuroradiology, University of Miami, Miami, Florida, USA; (9) Department of Neurosurgery, Mount Sinai Health System, New York City, New York, USA.

    • Contributors Concept design: KMF, AMS, SQW. Manuscript composition: CT, KMF, AMS, SQW, PB, CK. Data collection: all authors. Statistical analysis: CK. Final approval of article: all authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval IRB approval obtained at each participating center. Primary center: Institutional Review Board for Human Research at the Medical University of South Carolina: IRB # Pro00090704.

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

    • Data availability statement All data relevant to the study are included in the article.