Outcome, efficacy and safety of endovascular thrombectomy in ischaemic stroke according to time to reperfusion: data from a multicentre registry.

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Version: Final published version
License: CC BY-NC 4.0
Serval ID
serval:BIB_ADF5A95C3313
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Outcome, efficacy and safety of endovascular thrombectomy in ischaemic stroke according to time to reperfusion: data from a multicentre registry.
Journal
Therapeutic advances in neurological disorders
Author(s)
Meinel T.R., Kaesmacher J., Mordasini P., Mosimann P.J., Jung S., Arnold M., Heldner M.R., Michel P., Hajdu S.D., Ribo M., Requena M., Maegerlein C., Friedrich B., Costalat V., Benali A., Pierot L., Gawlitza M., Schaafsma J., Pereira V.M., Gralla J., Fischer U.
ISSN
1756-2856 (Print)
ISSN-L
1756-2856
Publication state
Published
Issued date
2019
Peer-reviewed
Oui
Volume
12
Pages
1756286419835708
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
In acute ischaemic stroke (AIS) of the anterior circulation (AC) treated with mechanical thrombectomy (MT), data point to a decline of treatment effect with increasing time from symptom onset to treatment. However, the magnitude of the decline will depend on the clinical setting and imaging selection used. The aims of this study were (1) to evaluate the clinical effect of time to reperfusion (TTR); and (2) to assess the safety and technical efficacy of MT according to strata of TTR.
Using the retrospective multicentre BEYOND-SWIFT registry data (ClinicalTrials.gov identifier: NCT03496064), we compared safety and efficacy of MT in 1461 patients between TTR strata of 0-180 min (n = 192), 180-360 min (n = 876) and >360 min (n = 393). Clinical effect of TTR was evaluated using multivariable logistic regression analyses adjusting for pre-specified confounders [adjusted odds ratios (aOR) and 95% confidence intervals (95% CI)]. Primary outcome was good functional outcome (modified Rankin Scale: mRS 0-2) at day 90.
Every hour delay in TTR was a significant factor related to mRS 0-2 (aOR 0.933, 95% CI 0.887-0.981) with an estimated 1.5% decreased probability of good functional outcome per hour delay of reperfusion, and mRS 0-1 (aOR 0.929, 95% CI 0.877-0.985). Patients with late TTR had lower rates of successful and excellent reperfusion, higher complication rates and number of passes.
TTR is an independent factor related to long-term functional outcome. With increasing TTR, interventional procedures become technically less effective. Efforts should be made to shorten TTR through optimized prehospital and in-hospital pathways.
Keywords
endovascular, mechanical thrombectomy, stroke, symptom onset, thrombolysis, time to reperfusion, time to treatment
Pubmed
Web of science
Open Access
Yes
Create date
22/04/2019 14:28
Last modification date
24/12/2019 6:20
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