Complete reperfusion mitigates influence of treatment time on outcomes after acute stroke.

By:Prabhakaran S1, Castonguay AC2, Gupta R3, Sun CJ4, Martin CO5, Holloway W5, Mueller-Kronast NH6, English J7, Linfante I8, Dabus G8, Malisch T9, Marden F9, Bozorgchami H10, Xavier A11, Rai A12, Froehler M12,13, Badruddin A14, Taqi MA15, Novakovic R16, Abraham M17, Janardhan V18, Shaltoni H19, Yoo AJ18, Abou-Chebl A18, Chen P19, Britz G20, Kaushal R21, Nanda A22, Nogueira R4, Nguyen T23, Zaidat OO24.|Date: April 09, 2017|Source: J Neurointerv Surg. 2017 Apr;9(4):366-369. doi: 10.1136/neurintsurg-2016-012288. Epub 2016 Apr 12.

Abstract

BACKGROUND:

Time to reperfusion following endovascular treatment (ET) predicts outcomes after acute ischemic stroke (AIS).

OBJECTIVE:

To assess the time-outcome relationship within reperfusion grades in the North American Solitaire Acute Stroke registry.

METHODS:

We 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.

RESULTS:

Independent 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.

CONCLUSIONS:

Time 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.

https://www.ncbi.nlm.nih.gov/pubmed/27073195