Microcatheter to Recanalization (Procedure Time) Predicts Outcomes in Endovascular Treatment in Patients with Acute Ischemic Stroke: When Do We Stop?

Hassan, Ameer E; Chaudhry, Saqib A; Miley, Jefferson T.; Khatri, Rakesh; Hassan, Summer; Suri, M. Fareed K.; Qureshi, Adnan I.

doi:10.3174/ajnr.a3202

Cited by 49 publications

(34 citation statements)

References 24 publications

(31 reference statements)

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“…In the poor collateral group, PRT of Ͼ60 minutes was strongly associated with decreased odds of favorable outcome, which can be a practical marker for the determination of endovascular therapy termination. A previous study showed that the procedural time in intra-arterial treatment is a critical determinant of outcomes, 28 and further negative impact on favorable outcome was shown in the poor collateral group in our study.…”

Section: Discussionsupporting

confidence: 46%

Impact of Time-to-Reperfusion on Outcome in Patients with Poor Collaterals

Hwang

Kang²,

Kim³

et al. 2014

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:The relationship between reperfusion and clinical outcome is time-dependent, and the effect of reperfusion on outcome can vary on the basis of the extent of collateral flow. We aimed to identify the impact of time-to-reperfusion on outcome relative to baseline angiographic collateral grade in patients successfully treated with endovascular revascularization for acute large-vessel anterior circulation stroke.

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Section: Discussionsupporting

confidence: 46%

Impact of Time-to-Reperfusion on Outcome in Patients with Poor Collaterals

Hwang

Kang²,

Kim³

et al. 2014

AJNR Am J Neuroradiol

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“…A recent study highlighted the possibility of using procedure time as an appropriate metric for predicting patient outcomes, with target goals of <60 minutes. 20 Although the time to successful reperfusion may hold more physiological relevance than puncture time in determining treatment efficacy, difficulty remains in quantifying this end point because of the presence of partial recanalization that occurs before complete revascularization. 21 Despite advances in device technology to enhance reperfusion rates and reduce procedure times, outcomes have not yet improved, 6,22 which may reflect our current systems of care in transferring patients.…”

Section: Discussionmentioning

confidence: 99%

“Picture to Puncture”

et al. 2013

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Background— Comprehensive stroke centers allow for regionalization of subspecialty stroke care. Efficacy of endovascular treatments, however, may be limited by delays in patient transfer. Our goal was to identify where these delays occurred and to assess the impact of such delays on patient outcome. Methods and Results— This was a retrospective study evaluating patients treated with endovascular therapy from November 2010 to July 2012 at our institution. We compared patients transferred from outside hospitals with locally treated patients with respect to demographics, imaging, and treatment times. Good outcomes, as defined by 90-day modified Rankin Scale scores of 0 to 2, were analyzed by transfer status as well as time from initial computed tomography to groin puncture (“picture-to-puncture” time). A total of 193 patients were analyzed, with a mean age of 65.8±14.5 years and median National Institutes of Health Stroke Scale score of 19 (interquartile range, 15–23). More than two thirds of the patients (132 [68%]) were treated from referring facilities. Outside transfers were noted to have longer picture-to-puncture times (205 minutes [interquartile range, 162–274] versus 89 minutes [interquartile range, 70–119]; P <0.001), which was attributable to the delays in transfer. This corresponded to fewer patients with favorable Alberta Stroke Program Early CT Scores on preprocedural computed tomographic imaging (Alberta Stroke Program Early CT Scores >7: 50% versus 76%; P <0.001) and significantly worse clinical outcomes (29% versus 51%; P =0.003). In a logistic regression model, picture-to-puncture times were independently associated with good outcomes (odds ratio, 0.994; 95% confidence interval, 0.990–0.999; P =0.009). Conclusions— Delays in picture-to-puncture times for interhospital transfers reduce the probability of good outcomes among treated patients. Strategies to reduce such delays herald an opportunity for hospitals to improve patient outcomes.

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“…A sensitivity analysis was performed after exclusion of the study with only discharge outcomes. 11 Finally, we repeated the pooled analysis with the use of a 2-stage meta-analysis approach in which individual logistic regression models were fit for each study and summarized by use of random-effects meta-analysis. 17 Because of the small sample sizes in the individual studies, we included only age and pretreatment NIHSS score in the multivariable analysis.…”

Section: Discussionmentioning

confidence: 99%

“…All studies were approved by local institutional review boards. Observational data sources included 1 center in France (University Bichat Hospital, Paris), 9 1 center in Spain (Vall D' Hebron Hospital, Barcelona), 10 a multicenter data set in the United States (University of Minnesota, Hennepin County Medical Centers, University of Medicine and Dentistry of New Jersey), 11 1 center in the Czech Republic (University Ostrava Hospital), 12 and 1 center in the United States (University of Buffalo, New York). 13 A pooled analysis of the 2 IMS trials 3 and a single-center experience study 2 have previously reported the impact of ORT on good clinical outcome, but none has studied associations with 90-day mortality.…”

Section: Data Sourcesmentioning

confidence: 99%

“…Intracranial hemorrhage was defined and classified according to the European Cooperative Acute Stroke Study (ECASS) as hemorrhagic infarction and parenchymal hemorrhage. 15,16 The mRS score and mortality were assessed at discharge in 1 study 11 and at 90 days in the remaining 6 studies (during face-to-face interviews or via telephone calls according to the study protocols).…”

Section: Eligibility Data Collection and Definitionsmentioning

confidence: 99%

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Impact of Onset-to-Reperfusion Time on Stroke Mortality

et al. 2013

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Background-Onset-to-reperfusion time has been reported to be associated with clinical prognosis. However, its impact on mortality remained to be assessed. Using a collaborative pooled analysis, we examined whether early mortality after successful endovascular treatment is time dependent. Methods and Results-In a collaborative pooled analysis of 7 endovascular databases, we assessed the impact of onsetto-reperfusion time in large-artery occlusion (internal carotid artery or middle cerebral artery) on outcomes. Successful reperfusion was defined as complete or partial restoration of blood flow within 8 hours from symptom onset. Primary outcome was 90-day all-cause mortality. Secondary outcomes included 90-day favorable outcome (modified Rankin Scale score, 0-2), 90-day excellent outcome (modified Rankin Scale score, 0-1), and occurrence of any intracerebral hemorrhage within 24 to 36 hours after treatment. A total of 480 cases with successful reperfusion (median time, 285 minutes) contributed to the present pooled analysis (120 with internal carotid artery occlusion and 360 with isolated middle cerebral artery occlusion). Increasing onset-to-reperfusion time was associated with an increased rate of mortality and intracerebral hemorrhage and with a decreased rate of favorable and excellent outcomes, without heterogeneity across studies. The adjusted odds ratio for each 30-minute time increase was 1.21 (95% confidence interval, 1.09-1.34; P<0.001) for mortality, 0.79 (95% confidence interval, 0.72-0.87) for favorable outcome, 0.78 (95% confidence interval, 0.71-0.86) for excellent outcome, and 1.21 (95% confidence interval, 1.10-1.33) for intracerebral hemorrhage. Conclusion-Onset-to-reperfusion time affects mortality and favorable outcome and should be considered the main goal in acute stroke patient management. (Circulation. 2013;127:1980-1985 13 A pooled analysis of the 2 IMS trials 3 and a single-center experience study 2 have previously reported the impact of ORT on good clinical outcome, but none has studied associations with 90-day mortality. The methodologies (study period, treatment specificities, baseline characteristics, and outcomes) of the 7 studies are summarized in Table 1. Eligibility, Data Collection, and DefinitionsPatients were eligible for inclusion in this study if they (1) had a largeartery occlusion (intracranial internal carotid artery or middle cerebral artery, M1 or M2) treated by an endovascular approach (thrombolysis or mechanical endovascular therapy) with or without prior use of intravenous thrombolysis; (2) had a successful angiographic reperfusion within 8 hours from symptom onset, defined as a complete or partial restoration of blood flow (Thrombolysis in Myocardial Infarction grade 2-3) 14 ; and (3) had available information on vital status. Data from individual patients were collected on a standardized form with predefined variables and were compiled and analyzed at the coordinating center (University Bichat Hospital, Paris). The following variables were collected: age; sex; initia...

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Microcatheter to Recanalization (Procedure Time) Predicts Outcomes in Endovascular Treatment in Patients with Acute Ischemic Stroke: When Do We Stop?

Cited by 49 publications

References 24 publications

Impact of Time-to-Reperfusion on Outcome in Patients with Poor Collaterals

Impact of Time-to-Reperfusion on Outcome in Patients with Poor Collaterals

“Picture to Puncture”

Impact of Onset-to-Reperfusion Time on Stroke Mortality

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