PT  - JOURNAL ARTICLE
AU  - Prabhakaran, Shyam
AU  - Castonguay, Alicia C
AU  - Gupta, Rishi
AU  - Sun, Chung-Huan J
AU  - Martin, Coleman O
AU  - Holloway, William
AU  - Mueller-Kronast, Nils H
AU  - English, Joey
AU  - Linfante, Italo
AU  - Dabus, Guilherme
AU  - Malisch, Tim
AU  - Marden, Franklin
AU  - Bozorgchami, Hormozd
AU  - Xavier, Andrew
AU  - Rai, Ansaar
AU  - Froehler, Michael
AU  - Badruddin, Aamir
AU  - Taqi, Mohammad Asif
AU  - Novakovic, Roberta
AU  - Abraham, Michael
AU  - Janardhan, Vallabh
AU  - Shaltoni, Hashem
AU  - Yoo, Albert J
AU  - Abou-Chebl, Alex
AU  - Chen, Peng
AU  - Britz, Gavin
AU  - Kaushal, Ritesh
AU  - Nanda, Ashish
AU  - Nogueira, Raul
AU  - Nguyen, Thanh
AU  - Zaidat, Osama O
TI  - Complete reperfusion mitigates influence of treatment time on outcomes after acute stroke
AID  - 10.1136/neurintsurg-2016-012288
DP  - 2017 Apr 01
TA  - Journal of NeuroInterventional Surgery
PG  - 366--369
VI  - 9
IP  - 4
4099  - http://jnis.bmj.com/content/9/4/366.short
4100  - http://jnis.bmj.com/content/9/4/366.full
SO  - J NeuroIntervent Surg2017 Apr 01; 9
AB  - 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.