Effect of Pre- and In-Hospital Delay on Reperfusion in Acute Ischemic Stroke Mechanical Thrombectomy.

Kaesmacher, Johannes; Maamari, Basel; Meinel, Thomas R.; Piechowiak, Eike I.; Mosimann, Pascal J.; Mordasini, Pasquale; Goeldin, Martina; Arnold, Marcel; Dobrocky, Tomas; Boeckh-Behrens, Tobias; Berndt, Maria; Michel, Patrik; Requena, Manuel; Benali, Amel; Pierot, Laurent; Mendes Pereira, Vitor; Boulouis, Grégoire; Brehm, Alex; Sporns, Peter B; Ospel, Johanna M; ... (2020). Effect of Pre- and In-Hospital Delay on Reperfusion in Acute Ischemic Stroke Mechanical Thrombectomy. Stroke, 51(10), pp. 2934-2942. Wolters Kluwer Health 10.1161/STROKEAHA.120.030208

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BACKGROUND AND PURPOSE

Post hoc analyses of randomized controlled clinical trials evaluating mechanical thrombectomy have suggested that admission-to-groin-puncture (ATG) delays are associated with reduced reperfusion rates. Purpose of this analysis was to validate this association in a real-world cohort and to find associated factors and confounders for prolonged ATG intervals.

METHODS

Patients included into the BEYOND-SWIFT cohort (Bernese-European Registry for Ischemic Stroke Patients Treated Outside Current Guidelines With Neurothrombectomy Devices Using the Solitaire FR With the Intention for Thrombectomy; https://www.clinicaltrials.gov; Unique identifier: NCT03496064) were analyzed (n=2386). Association between baseline characteristics and ATG was evaluated using mixed linear regression analysis. The effect of increasing symptom-onset-to-admission and ATG intervals on successful reperfusion (defined as Thrombolysis in Cerebral Infarction [TICI] 2b-3) was evaluated using logistic regression analysis adjusting for potential confounders.

RESULTS

Median ATG was 73 minutes. Prolonged ATG intervals were associated with the use of magnetic resonance imaging (+19.1 [95% CI, +9.1 to +29.1] minutes), general anesthesia (+12.1 [95% CI, +3.7 to +20.4] minutes), and borderline indication criteria, such as lower National Institutes of Health Stroke Scale, late presentations, or not meeting top-tier early time window eligibility criteria (+13.8 [95% CI, +6.1 to +21.6] minutes). There was a 13% relative odds reduction for TICI 2b-3 (adjusted odds ratio [aOR], 0.87 [95% CI, 0.79-0.96]) and TICI 2c/3 (aOR, 0.87 [95% CI, 0.79-0.95]) per hour ATG delay, while the reduction of TICI 2b-3 per hour increase symptom-onset-to-admission was minor (aOR, 0.97 [95% CI, 0.94-0.99]) and inconsistent regarding TICI 2c/3 (aOR, 0.99 [95% CI, 0.97-1.02]). After adjusting for identified factors associated with prolonged ATG intervals, the association of ATG delay and lower rates of TICI 2b-3 remained tangible (aOR, 0.87 [95% CI, 0.76-0.99]).

CONCLUSIONS

There is a great potential to reduce ATG, and potential targets for improvement can be deduced from observational data. The association between in-hospital delay and reduced reperfusion rates is evident in real-world clinical data, underscoring the need to optimize in-hospital workflows. Given the only minor association between symptom-onset-to-admission intervals and reperfusion rates, the causal relationship of this association warrants further research. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03496064.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Kaesmacher, Johannes; Maamari, Basel; Meinel, Thomas Raphael; Piechowiak, Eike Immo; Mosimann, Pascal John; Mordasini, Pasquale; Göldlin, Martina Béatrice; Arnold, Marcel; Dobrocky, Tomas; Gralla, Jan and Fischer, Urs

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1524-4628

Publisher:

Wolters Kluwer Health

Language:

English

Submitter:

Maria de Fatima Henriques Bernardo

Date Deposited:

18 Sep 2020 10:09

Last Modified:

30 Sep 2020 01:33

Publisher DOI:

10.1161/STROKEAHA.120.030208

PubMed ID:

32933420

Uncontrolled Keywords:

odds ratio reperfusion thrombectomy workflow

BORIS DOI:

10.7892/boris.146554

URI:

https://boris.unibe.ch/id/eprint/146554

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