A P Wessell1, H D P Carvalho2, E Le2, G Cannarsa3, M J Kole3, J A Stokum3, T Chryssikos3, T R Miller2, S Chaturvedi4, D Gandhi2, K Yarbrough4, S R Satti5, G Jindal2. 1. Departments of Neurosurgery (A.P.W., G.C., M.J.K., J.A.S., T.C.) apwessell@gmail.com. 2. From the Division of Interventional Neuroradiology (H.D.P.C., E.L., T.R.M., D.G., G.J.). 3. Departments of Neurosurgery (A.P.W., G.C., M.J.K., J.A.S., T.C.). 4. Neurology (S.C., K.Y.), University of Maryland Medical Center, Baltimore, Maryland. 5. Department of Neurointerventional Surgery (S.R.S.), Christiana Care Health System, Newark, Delaware.
Abstract
BACKGROUND AND PURPOSE: Previous studies in acute ischemic stroke have demonstrated the importance of minimizing delays to endovascular treatment and keeping thrombectomy procedural times at <30-60 minutes. The purpose of this study was to investigate the impact of thrombectomy procedural times on clinical outcomes. MATERIALS AND METHODS: We retrospectively compared 319 patients having undergone thrombectomy according to procedural time (<30 minutes, 30-60 minutes, and >60 minutes) and time from stroke onset to endovascular therapy (≤6 or >6 hours). Clinical characteristics of patients with postprocedural intracranial hemorrhage were also assessed. Logistic regression was used to determine independent predictors of poor outcome at 90 days (mRS ≥3). RESULTS: Greater age (OR, 1.03; 95% CI, 1.01-1.06; P = .016), higher admission NIHSS score (OR, 1.10; 95% CI, 1.04-1.16; P = .001), history of diabetes mellitus (OR, 1.96; 95% CI, 1.05-3.65; P = .034), and postprocedural intracranial hemorrhage were independently associated with greater odds of poor outcome. Modified TICI scale scores of 2c (OR, 0.11; 95% CI, 0.04-0.28; P < .001) and 3 (OR, 0.15; 95% CI, 0.06-0.38; P < .001) were associated with reduced odds of poor outcome. Although not statistically significant on univariate analysis, onset to endovascular therapy of >6 hours was independently associated with increased odds of poor outcome (OR, 2.20; 95% CI, 1.11-4.36; P = .024) in the final multivariate model (area under the curve = 0.820). Procedural time was not independently associated with clinical outcome in the final multivariate model (P > .05). CONCLUSIONS: Thrombectomy procedural times beyond 60 minutes are associated with lower revascularization rates and worse 90-day outcomes. Procedural time itself was not an independent predictor of outcome. While stroke thrombectomy procedures should be performed rapidly, our study emphasizes the significance of achieving revascularization despite the requisite procedural time. However, the potential for revascularization must be weighed against the risks associated with multiple thrombectomy attempts.
BACKGROUND AND PURPOSE: Previous studies in acute ischemic stroke have demonstrated the importance of minimizing delays to endovascular treatment and keeping thrombectomy procedural times at <30-60 minutes. The purpose of this study was to investigate the impact of thrombectomy procedural times on clinical outcomes. MATERIALS AND METHODS: We retrospectively compared 319 patients having undergone thrombectomy according to procedural time (<30 minutes, 30-60 minutes, and >60 minutes) and time from stroke onset to endovascular therapy (≤6 or >6 hours). Clinical characteristics of patients with postprocedural intracranial hemorrhage were also assessed. Logistic regression was used to determine independent predictors of poor outcome at 90 days (mRS ≥3). RESULTS: Greater age (OR, 1.03; 95% CI, 1.01-1.06; P = .016), higher admission NIHSS score (OR, 1.10; 95% CI, 1.04-1.16; P = .001), history of diabetes mellitus (OR, 1.96; 95% CI, 1.05-3.65; P = .034), and postprocedural intracranial hemorrhage were independently associated with greater odds of poor outcome. Modified TICI scale scores of 2c (OR, 0.11; 95% CI, 0.04-0.28; P < .001) and 3 (OR, 0.15; 95% CI, 0.06-0.38; P < .001) were associated with reduced odds of poor outcome. Although not statistically significant on univariate analysis, onset to endovascular therapy of >6 hours was independently associated with increased odds of poor outcome (OR, 2.20; 95% CI, 1.11-4.36; P = .024) in the final multivariate model (area under the curve = 0.820). Procedural time was not independently associated with clinical outcome in the final multivariate model (P > .05). CONCLUSIONS: Thrombectomy procedural times beyond 60 minutes are associated with lower revascularization rates and worse 90-day outcomes. Procedural time itself was not an independent predictor of outcome. While stroke thrombectomy procedures should be performed rapidly, our study emphasizes the significance of achieving revascularization despite the requisite procedural time. However, the potential for revascularization must be weighed against the risks associated with multiple thrombectomy attempts.
Authors: Shlomi Peretz; Guy Raphaeli; Natan Borenstein; Ronen R Leker; Ran Brauner; Anat Horev; José E Cohen; Gregory Telman; Hen Halevi; David Tanne Journal: J Neurointerv Surg Date: 2019-06-25 Impact factor: 5.836
Authors: Ali Alawieh; Jan Vargas; Kyle M Fargen; E Farris Langley; Robert M Starke; Reade De Leacy; Rano Chatterjee; Ansaar Rai; Travis Dumont; Peter Kan; David McCarthy; Fábio A Nascimento; Jasmeet Singh; Lukas Vilella; Aquilla Turk; Alejandro M Spiotta Journal: J Am Coll Cardiol Date: 2019-03-05 Impact factor: 24.094
Authors: Donald Lloyd-Jones; Robert Adams; Mercedes Carnethon; Giovanni De Simone; T Bruce Ferguson; Katherine Flegal; Earl Ford; Karen Furie; Alan Go; Kurt Greenlund; Nancy Haase; Susan Hailpern; Michael Ho; Virginia Howard; Brett Kissela; Steven Kittner; Daniel Lackland; Lynda Lisabeth; Ariane Marelli; Mary McDermott; James Meigs; Dariush Mozaffarian; Graham Nichol; Christopher O'Donnell; Veronique Roger; Wayne Rosamond; Ralph Sacco; Paul Sorlie; Randall Stafford; Julia Steinberger; Thomas Thom; Sylvia Wasserthiel-Smoller; Nathan Wong; Judith Wylie-Rosett; Yuling Hong Journal: Circulation Date: 2009-01-27 Impact factor: 29.690
Authors: Osama O Zaidat; Alicia C Castonguay; Italo Linfante; Rishi Gupta; Coleman O Martin; William E Holloway; Nils Mueller-Kronast; Joey D English; Guilherme Dabus; Tim W Malisch; Franklin A Marden; Hormozd Bozorgchami; Andrew Xavier; Ansaar T Rai; Michael T Froehler; Aamir Badruddin; Thanh N Nguyen; M Asif Taqi; Michael G Abraham; Albert J Yoo; Vallabh Janardhan; Hashem Shaltoni; Roberta Novakovic; Alex Abou-Chebl; Peng R Chen; Gavin W Britz; Chung-Huan J Sun; Vibhav Bansal; Ritesh Kaushal; Ashish Nanda; Raul G Nogueira Journal: Stroke Date: 2018-02-19 Impact factor: 7.914
Authors: Daniel A Tonetti; Shashvat M Desai; Stephanie Casillo; Jeremy Stone; Merritt Brown; Brian Jankowitz; Tudor G Jovin; Bradley A Gross; Ashutosh Jadhav Journal: J Neurointerv Surg Date: 2019-11-01 Impact factor: 5.836