RT Journal Article
SR Electronic
T1 Comprehensive analysis of the impact of procedure time and the ‘golden hour’ in subpopulations of stroke thrombectomy patients
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 1069
OP 1075
DO 10.1136/jnis-2023-020792
VO 16
IS 11
A1 Ash, Makenna
A1 Dimisko, Laurie
A1 Chalhoub, Reda M
A1 Howard, Brian M
A1 Cawley, C Michael
A1 Matouk, Charles
A1 Pabaney, Aqueel
A1 Spiotta, Alejandro M
A1 Jabbour, Pascal
A1 Maier, Ilko
A1 Wolfe, Stacey Q
A1 Rai, Ansaar T
A1 Kim, Joon-tae
A1 Psychogios, Marios-Nikos
A1 Mascitelli, Justin R
A1 Starke, Robert M
A1 Shaban, Amir
A1 Yoshimura, Shinichi
A1 De Leacy, Reade
A1 Kan, Peter
A1 Fragata, Isabel
A1 Polifka, Adam J
A1 Arthur, Adam S
A1 Park, Min S
A1 Crosa, Roberto Javier
A1 Williamson, Richard
A1 Dumont, Travis M
A1 Levitt, Michael R
A1 Al Kasab, Sami
A1 Tjoumakaris, Stavropoula I
A1 Liman, Jan
A1 Saad, Hassan
A1 Samaniego, Edgar A
A1 Fargen, Kyle M
A1 Grossberg, Jonathan A
A1 Alawieh, Ali
A1 
YR 2024
UL http://jnis.bmj.com/content/16/11/1069.abstract
AB Objective To evaluate the effect of procedure time on thrombectomy outcomes in different subpopulations of patients undergoing endovascular thrombectomy (EVT), given the recently expanded indications for EVT.Methods This multicenter study included patients undergoing EVT for acute ischemic stroke at 35 centers globally. Procedure time was defined as time from groin puncture to successful recanalization (Thrombolysis in Cerebral Infarction score ≥2b) or abortion of procedure. Patients were stratified based on stroke location, use of IV tissue plasminogen activator (tPA), Alberta Stroke Program Early CT score, age group, and onset-to-groin time. Primary outcome was the 90-day modified Rankin Scale (mRS) score, with scores 0–2 designating good outcome. Secondary outcome was postprocedural symptomatic intracranial hemorrhage (sICH). Multivariate analyses were performed using generalized linear models to study the impact of procedure time on outcomes in each subpopulation.Results Among 8961 patients included in the study, a longer procedure time was associated with higher odds of poor outcome (mRS score 3–6), with 10% increase in odds for each 10 min increment. When procedure time exceeded the ‘golden hour’, poor outcome was twice as likely. The golden hour effect was consistent in patients with anterior and posterior circulation strokes, proximal or distal occlusions, in patients with large core infarcts, with or without IV tPA treatment, and across age groups. Procedures exceeding 1 hour were associated with a 40% higher sICH rate. Posterior circulation strokes, delayed presentation, and old age were the variables most sensitive to 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 sICH across different subpopulations of patients undergoing EVT.Data are available upon reasonable request.