Shyam Prabhakaran1, Alicia C Castonguay2, Rishi Gupta3, Chung-Huan J Sun4, Coleman O Martin5, William Holloway5, Nils H Mueller-Kronast6, Joey English7, Italo Linfante8, Guilherme Dabus8, Tim Malisch9, Franklin Marden9, Hormozd Bozorgchami10, Andrew Xavier11, Ansaar Rai12, Michael Froehler12,13, Aamir Badruddin14, Mohammad Asif Taqi15, Roberta Novakovic16, Michael Abraham17, Vallabh Janardhan18, Hashem Shaltoni19, Albert J Yoo18, Alex Abou-Chebl18, Peng Chen19, Gavin Britz20, Ritesh Kaushal21, Ashish Nanda22, Raul Nogueira4, Thanh Nguyen23, Osama O Zaidat24. 1. Northwestern University, Chicago, Illinois, USA. 2. University of Texas, MD Anderson, Houston, Texas, USA. 3. Wellstar Neurosurgery Kennestone Hospital, Atlanta, Georgia, USA. 4. Emory University School of Medicine, Atlanta, Georgia, USA. 5. Saint Luke's Kansas City, Kansas City, Missouri, USA. 6. Delray Medical Center, Delray Beach, Florida, USA. 7. California Pacific Medical Center, San Francisco, California, USA. 8. Baptist Cardiac and Vascular Institute, Miami, Florida, USA. 9. Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA. 10. Oregon Health and Science University, Portland, Oregon, USA. 11. Wayne State University School of Medicine, Detroit, Michigan, USA. 12. West Virginia University Hospital, Morgantown, West Virginia, USA. 13. Vanderbilt University Medical Center, Nashville, Tennessee, USA. 14. Provena Saint Joseph Medical Center, Joliet, Illinois, USA. 15. Desert Regional Medical Center, Palm Springs, California, USA. 16. University of Texas Southwestern Medical Center, USA. 17. University of Kansas Medical Center, Kansas City, Kansas, USA. 18. Texas Stroke Institute, Plano, Texas, USA. 19. University of Texas Health Science Center, Houston, Texas, USA. 20. Methodist Neurological Institute, Houston, Texas, USA. 21. Saint Louis University, St Louis, Missouri, USA. 22. University of Missouri, Columbia, Missouri, USA. 23. Boston Medical Center, Boston, Massachusetts, USA. 24. St Vincent Mercy Medical Center, Toledo, Ohio, USA.
Abstract
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Authors: S Prothmann; B Friedrich; T Boeckh-Behrens; C Zimmer; J Kaesmacher; K Lucia; C Maegerlein Journal: Clin Neuroradiol Date: 2017-01-12 Impact factor: 3.649
Authors: Yan Li; Natalie van Landeghem; Aydin Demircioglu; Martin Köhrmann; Elias Kellner; Lennart Milles; Benjamin Stolte; Andreas Totzeck; Philipp Dammann; Karsten Wrede; Jens Matthias Theysohn; Hanna Styczen; Michael Forsting; Isabel Wanke; Benedikt Frank; Cornelius Deuschl Journal: Clin Neuroradiol Date: 2022-03-04 Impact factor: 3.156