The golden hour of stroke intervention: effect of thrombectomy procedural time in acute ischemic stroke on outcome

Spiotta, Alejandro M; Vargas, Jan; Turner, Raymond D; Chaudry, M Imran; Battenhouse, Holly; Turk, Aquilla S

doi:10.1136/neurintsurg-2013-010726

Cited by 94 publications

(84 citation statements)

References 23 publications

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“…Our overall favorable outcome rate (35.3%) is comparable to that of MR CLEAN (32.6%), which can be explained by similar inclusion criteria, periprocedural timings, and the IVT rate [18]. The same holds good in comparison to large case series or registries with favorable outcomes up to 70% [2,3,13,24,26,30,35]. Our rate of concomitant IVT was in line with published registry data and not significantly different between ILVO and CLVO groups [36].…”

Section: Discussionsupporting

confidence: 58%

“…In our study, the overall rate of successful reperfusion (79.9%) is within the range of core-lab controlled results (58.7-88%) [18,19,20,21,22], yet lower than that in self-reported series with reperfusion rates up to 91% [2,3,13,15,16,24,25,26,27]. One putative explanation might be the blinded regrading of all digital subtraction angiography images according to the Cerebral Angiographic Revascularization Grading standards, thereby ensuring common operator-independent grading standards over time.…”

Section: Discussionmentioning

confidence: 92%

“…In underlying large vessel occlusion (LVO), several cofactors affect the functional outcome, for example, anatomic location, patient age, National Institutes of Health Stroke Scale (NIHSS) on admission, angiographic reperfusion result, and concomitant intravenous thrombolysis (IVT) [1,2,3,4]. Clinical outcome improves with swift and complete reperfusion but also depends on the core infarct size in relation to the potentially salvageable tissue (“penumbra”) and collateral status [5,6,7].…”

Section: Introductionmentioning

confidence: 99%

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Incomplete Large Vessel Occlusions in Mechanical Thrombectomy: An Independent Predictor of Favorable Outcome in Ischemic Stroke

Maus¹,

You²,

Kalkan³

et al. 2017

Cerebrovasc Dis

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Background and Purpose: Cerebral large vessel occlusion (LVO) in acute ischemic stroke (AIS) may be complete (CLVO) or incomplete (ILVO). The influence of ILVO on clinical outcome after mechanical thrombectomy (MT) remains unclear. We investigated primarily the clinical outcome in patients with AIS due to ILVO or CLVO. Methods: Five hundred three consecutive AIS patients with LVO treated with stent-retriever or direct aspiration-based MT between 2010 and 2016 were analyzed. The primary endpoint was favorable clinical outcome (modified Rankin Scale ≤2) at 90 days; secondary endpoints were periprocedural parameters. Results: Forty-nine patients (11.3%) with a median National Institutes of Health Stroke Scale (NIHSS) of 11 presented with ILVO and the remainder presented with CLVO and median NIHSS of 15 (p < 0.001). The median groin puncture-to-reperfusion time was 30 vs. 67 min, respectively (p < 0.001). Successful reperfusion was reached in 47 out of 49 ILVO (95.9%) vs. 298 out of 381 CLVO (78.2%; p < 0.005) with less retrieval maneuvers (1.7 ± 2.2 vs. 3.0 ± 2.5; p < 0.001). The favorable outcome at 90 days was 81% in patients with ILVO vs. 29.1% in CLVO (p < 0.001); respective all-cause mortality rates were 6.4 vs. 28.5% (p < 0.001). Periprocedural complications (6.9%) occurred exclusively in CLVO patients (p < 0.05). ILVO was associated with favorable clinical outcome independent of age and NIHSS in multivariate logistic regression both in the anterior (OR 3.6; 95% CI 1.8-6.9; p < 0.001) and posterior circulation (OR 3.5; 95% CI 1.8-6.9; p < 0.001). Conclusions: AIS due to ILVO is frequent and is associated with a nearly threefold higher chance of favorable clinical outcome at 90 days, independent of age and initial NIHSS compared to CLVO.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Incomplete Large Vessel Occlusions in Mechanical Thrombectomy: An Independent Predictor of Favorable Outcome in Ischemic Stroke

Maus¹,

You²,

Kalkan³

et al. 2017

Cerebrovasc Dis

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“…The median door-to-first angiography series time of 102 min achieved by the stroke room intervention was shorter than the time taken for start of treatment reported in most of the earlier studies [13,14,23,24] . However, the Eurostroke registry, which contains data from 12 stroke centers in Germany and Austria, reports median door-tofirst angiography series times of 91 min for patients with anterior circulation ischemia and of 99 min for patients with vertebrobasilar ischemia [20] .…”

Section: Discussionmentioning

confidence: 82%

“…Importantly, it is increasingly becoming clear that, as is the case with IV thrombolysis, the time of starting IAT is a most important determinant of clinical outcome [8][9][10][11][12][13][14] . For example, it has been estimated that for every 30-minute delay in reperfusion, the relative likelihood of a good clinical outcome decreases by approximately 15% [13,15] .…”

Section: Introductionmentioning

confidence: 99%

‘Stroke Room': Diagnosis and Treatment at a Single Location for Rapid Intraarterial Stroke Treatment

Ragoschke-Schumm¹,

Yılmaz²,

Kostopoulos³

et al. 2015

Cerebrovasc Dis

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Background: For patients with acute ischemic stroke, intra-arterial treatment (IAT) is considered to be an effective strategy for removing the obstructing clot. Because outcome crucially depends on time to treatment (‘time-is-brain' concept), we assessed the effects of an intervention based on performing all the time-sensitive diagnostic and therapeutic procedures at a single location on the delay before intra-arterial stroke treatment. Methods: Consecutive acute stroke patients with large vessel occlusion who obtained IAT were evaluated before and after implementation (April 26, 2010) of an intervention focused on performing all the diagnostic and therapeutic measures at a single site (‘stroke room'). Result: After implementation of the intervention, the median intervals between admission and first angiography series were significantly shorter for 174 intervention patients (102 min, interquartile range (IQR) 85-120 min) than for 81 control patients (117 min, IQR 89-150 min; p < 0.05), as were the intervals between admission and clot removal or end of angiography (152 min, IQR 123-185 min vs. 190 min, IQR 163-227 min; p < 0.001). However, no significant differences in clinical outcome were observed. Conclusion: This study shows for the, to our knowledge, first time that for patients with acute ischemic stroke, stroke diagnosis and treatment at a single location (‘stroke room') saves crucial time until IAT.

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Impact of Time on Thrombolysis in Cerebral Infarction Score Results

et al. 2019

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The golden hour of stroke intervention: effect of thrombectomy procedural time in acute ischemic stroke on outcome

Abstract: Our findings suggest that extending mechanical thrombectomy procedure times beyond 60 min increases complications and device cost rates while worsening outcomes. These findings can serve as a time frame of when it is prudent to abort a failed thrombectomy case.

Cited by 94 publications

References 23 publications

Incomplete Large Vessel Occlusions in Mechanical Thrombectomy: An Independent Predictor of Favorable Outcome in Ischemic Stroke

Incomplete Large Vessel Occlusions in Mechanical Thrombectomy: An Independent Predictor of Favorable Outcome in Ischemic Stroke

‘Stroke Room': Diagnosis and Treatment at a Single Location for Rapid Intraarterial Stroke Treatment

Impact of Time on Thrombolysis in Cerebral Infarction Score Results

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