RT Journal Article
SR Electronic
T1 Complete reperfusion mitigates influence of treatment time on outcomes after acute stroke
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 366
OP 369
DO 10.1136/neurintsurg-2016-012288
VO 9
IS 4
A1 Prabhakaran, Shyam
A1 Castonguay, Alicia C
A1 Gupta, Rishi
A1 Sun, Chung-Huan J
A1 Martin, Coleman O
A1 Holloway, William
A1 Mueller-Kronast, Nils H
A1 English, Joey
A1 Linfante, Italo
A1 Dabus, Guilherme
A1 Malisch, Tim
A1 Marden, Franklin
A1 Bozorgchami, Hormozd
A1 Xavier, Andrew
A1 Rai, Ansaar
A1 Froehler, Michael
A1 Badruddin, Aamir
A1 Taqi, Mohammad Asif
A1 Novakovic, Roberta
A1 Abraham, Michael
A1 Janardhan, Vallabh
A1 Shaltoni, Hashem
A1 Yoo, Albert J
A1 Abou-Chebl, Alex
A1 Chen, Peng
A1 Britz, Gavin
A1 Kaushal, Ritesh
A1 Nanda, Ashish
A1 Nogueira, Raul
A1 Nguyen, Thanh
A1 Zaidat, Osama O
YR 2017
UL http://jnis.bmj.com/content/9/4/366.abstract
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.