Atte Meretoja1, Mahsa Keshtkaran2, Turgut Tatlisumak2, Geoffrey A Donnan2, Leonid Churilov2. 1. From The Florey Institute of Neuroscience and Mental Health (A.M., M.K., G.A.D., L.C.) and Department of Medicine at the Royal Melbourne Hospital (A.M.), University of Melbourne, Parkville, Australia; Department of Neurology (A.M., T.T.), Helsinki University Hospital, Finland; RMIT University (M.K., L.C.), Melbourne, Australia; Department of Clinical Neurosciences/Neurology (T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden. atte.meretoja@fimnet.fi. 2. From The Florey Institute of Neuroscience and Mental Health (A.M., M.K., G.A.D., L.C.) and Department of Medicine at the Royal Melbourne Hospital (A.M.), University of Melbourne, Parkville, Australia; Department of Neurology (A.M., T.T.), Helsinki University Hospital, Finland; RMIT University (M.K., L.C.), Melbourne, Australia; Department of Clinical Neurosciences/Neurology (T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden.
Abstract
OBJECTIVE: To quantify the patient lifetime benefits gained from reduced delays in endovascular therapy for acute ischemic stroke. METHODS: We used observational prospective data of consecutive stroke patients treated with IV thrombolysis in Helsinki (1998-2014; n = 2,474) to describe distributions of age, sex, stroke severity, onset-to-treatment times, and 3-month modified Rankin Scale (mRS) in routine clinical practice. We used treatment effects by time of endovascular therapy in large vessel occlusion over and above thrombolysis as reported by the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) study to model the shift in 3-month mRS distributions with reducing treatment delays. From the 3-month outcomes we derived patient-expected lifetimes and cumulative long-term disability with incremental treatment delay reductions. RESULTS: Each minute saved in onset-to-treatment time granted on average 4.2 days of extra healthy life, with a 95% prediction interval 2.3-5.4. Women gained slightly more than men due to their longer life expectancies. Patients younger than 55 years with severe strokes of NIH Stroke Scale score above 10 gained more than a week per each minute saved. In the whole cohort, every 20 minutes decrease in treatment delays led to a gain of average equivalent of 3 months of disability-free life. CONCLUSIONS: Small reductions in endovascular delays lead to marked health benefits over patients' lifetimes. Services need to be optimized to reduce delays to endovascular therapy.
OBJECTIVE: To quantify the patient lifetime benefits gained from reduced delays in endovascular therapy for acute ischemic stroke. METHODS: We used observational prospective data of consecutive strokepatients treated with IV thrombolysis in Helsinki (1998-2014; n = 2,474) to describe distributions of age, sex, stroke severity, onset-to-treatment times, and 3-month modified Rankin Scale (mRS) in routine clinical practice. We used treatment effects by time of endovascular therapy in large vessel occlusion over and above thrombolysis as reported by the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) study to model the shift in 3-month mRS distributions with reducing treatment delays. From the 3-month outcomes we derived patient-expected lifetimes and cumulative long-term disability with incremental treatment delay reductions. RESULTS: Each minute saved in onset-to-treatment time granted on average 4.2 days of extra healthy life, with a 95% prediction interval 2.3-5.4. Women gained slightly more than men due to their longer life expectancies. Patients younger than 55 years with severe strokes of NIH Stroke Scale score above 10 gained more than a week per each minute saved. In the whole cohort, every 20 minutes decrease in treatment delays led to a gain of average equivalent of 3 months of disability-free life. CONCLUSIONS: Small reductions in endovascular delays lead to marked health benefits over patients' lifetimes. Services need to be optimized to reduce delays to endovascular therapy.
Authors: Abdul Ghani Mikati; Max Mandelbaum; Shweta Sapnar; Ajit S Puri; Brian Silver; Richard P Goddeau; Diogo C Haussen; Majaz Moonis; Adalia H Jun-O'Connell; Nils Henninger Journal: Transl Stroke Res Date: 2019-04-12 Impact factor: 6.829
Authors: Mehul D Patel; Jackie Thompson; José G Cabañas; Jefferson G Williams; Erin Lewis; Michael Bachman; Mahmoud Al Masry; Charles LaVigne; Leonardo Morantes; Tibor Becske; Omar Kass-Hout Journal: J Neurointerv Surg Date: 2021-04-23 Impact factor: 5.836
Authors: Pauli E T Vuorinen; Jyrki P J Ollikainen; Pasi A Ketola; Riikka-Liisa K Vuorinen; Piritta A Setälä; Sanna E Hoppu Journal: Scand J Trauma Resusc Emerg Med Date: 2021-07-19 Impact factor: 2.953