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

Shyam Prabhakaran*, Alicia C. Castonguay, Rishi Gupta, Chung Huan J. Sun, Coleman O. Martin, William Holloway, Nils H. Mueller-Kronast, Joey English, Italo Linfante, Guilherme Dabus, Tim Malisch, Franklin Marden, Hormozd Bozorgchami, Andrew Xavier, Ansaar Rai, Michael Froehler, Aamir Badruddin, Mohammad Asif Taqi, Roberta Novakovic, Michael AbrahamVallabh Janardhan, Hashem Shaltoni, Albert J. Yoo, Alex Abou-Chebl, Peng Chen, Gavin Britz, Ritesh Kaushal, Ashish Nanda, Raul Nogueira, Thanh Nguyen, Osama O. Zaidat

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)366-369
Number of pages4
JournalJournal of neurointerventional surgery
Volume9
Issue number4
DOIs
StatePublished - Apr 2017

Keywords

  • Device
  • Stroke
  • Thrombectomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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