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Ann Neurol. 2015 Oct;78(4):584-93. doi: 10.1002/ana.24474. Epub 2015 Aug 17.

Time to endovascular reperfusion and degree of disability in acute stroke.

Author information

1
Division of Interventional Neuroradiology and Stroke Center, University of California, Los Angeles, CA.
2
Department of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland.
3
Departments of Medical Imaging and Surgery, Toronto Western Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada.
4
Department of Neurology, Emory University, Atlanta, GA.
5
Departments of Neurosurgery and Radiology and Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York.
6
Department of Neurology, Medical College of Wisconsin, Milwaukee, WI.
7
Department of Neurology and Stroke Center, University of California, Los Angeles, CA.

Abstract

OBJECTIVE:

Faster time from onset to recanalization (OTR) in acute ischemic stroke using endovascular therapy (ET) has been associated with better outcome. However, previous studies were based on less-effective first-generation devices, and analyzed only dichotomized disability outcomes, which may underestimate the full effect of treatment.

METHODS:

In the combined databases of the SWIFT and STAR trials, we identified patients treated with the Solitaire stent retriever with achievement of substantial reperfusion (Thrombolysis in Cerebral Infarction [TICI] 2b-3). Ordinal numbers needed to treat values were derived by populating joint outcome tables.

RESULTS:

Among 202 patients treated with ET with TICI 2b to 3 reperfusion, mean age was 68 (±13), 62% were female, and median National Institutes of Health Stroke Scale (NIHSS) score was 17 (interquartile range [IQR]: 14-20). Day 90 modified Rankin Scale (mRS) outcomes for OTR time intervals ranging from 180 to 480 minutes showed substantial time-related reductions in disability across the entire outcome range. Shorter OTR was associated with improved mean 90-day mRS (1.4 vs. 2.4 vs. 3.3, for OTR groups of 124-240 vs. 241-360 vs. 361-660 minutes; p < 0.001). The number of patients identified as benefitting from therapy with shorter OTR were 3-fold (range, 1.5-4.7) higher on ordinal, compared with dichotomized analysis. For every 15-minute acceleration of OTR, 34 per 1,000 treated patients had improved disability outcome.

INTERPRETATION:

Analysis of disability over the entire outcome range demonstrates a marked effect of shorter time to reperfusion upon improved clinical outcome, substantially higher than binary metrics. For every 5-minute delay in endovascular reperfusion, 1 of 100 patients has a worse disability outcome.

PMID:
26153450
PMCID:
PMC4955570
DOI:
10.1002/ana.24474
[Indexed for MEDLINE]
Free PMC Article

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