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

Sheth, Sunil A; Jahan, Reza; Gralla, Jan; Pereira, Vitor M; Nogueira, Raul G; Levy, Elad I; Zaidat, Osama O; Saver, Jeffrey L (2015). Time to endovascular reperfusion and degree of disability in acute stroke. Annals of neurology, 78(4), pp. 584-593. Wiley-Blackwell 10.1002/ana.24474

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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. Ann Neurol 2015;78:584-593.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Gralla, Jan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0364-5134

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

05 Oct 2015 09:15

Last Modified:

05 Oct 2015 09:15

Publisher DOI:

10.1002/ana.24474

PubMed ID:

26153450

BORIS DOI:

10.7892/boris.72157

URI:

https://boris.unibe.ch/id/eprint/72157

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