Complete reperfusion mitigates influence of treatment time on outcomes after acute stroke Article (Web of Science)

abstract

  • BackgroundTime to reperfusion following endovascular treatment (ET) predicts outcomes after acute ischemic stroke (AIS).ObjectiveTo assess the time–outcome relationship within reperfusion grades in the North American Solitaire Acute Stroke registry.MethodsWe 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.ResultsIndependent 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.ConclusionsTime 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.

authors

  • Prabhakaran, Shyam
  • Castonguay, Alicia
  • Gupta, Rishi
  • Sun, Chung-Huan J
  • Martin, Coleman O
  • Holloway, William
  • Mueller-Kronast, Nils H
  • English, Joey
  • Linfante, Italo
  • Dabus, Guilherme
  • Malisch, Tim
  • Marden, Franklin
  • Bozorgchami, Hormozd
  • Xavier, Andrew
  • Rai, Ansaar
  • Froehler, Michael
  • Badruddin, Aamir
  • Taqi, Mohammad Asif
  • Novakovic, Roberta
  • Abraham, Michael
  • Janardhan, Vallabh
  • Shaltoni, Hashem
  • Yoo, Albert J
  • Abou-Chebl, Alex
  • Chen, Peng
  • Britz, Gavin
  • Kaushal, Ritesh
  • Nanda, Ashish
  • Nogueira, Raul
  • Nguyen, Thanh
  • Zaidat, Osama O

publication date

  • 2017

number of pages

  • 3

start page

  • 366

end page

  • 369

volume

  • 9

issue

  • 4