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

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

  • Kaesmacher, Johannes ORCID University Institute of Diagnostic and Interventional and Pediatric Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland.
  • Maamari, Basel ORCID Department of Neurology (B.M., T.R.M., M.G., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland.
  • Meinel, Thomas R. Department of Neurology (B.M., T.R.M., M.G., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland.
  • Piechowiak, Eike I. University Institute of Diagnostic and Interventional Neuroradiology (J.K., E.I.P., P.J.M., P. Mordasini, T.D., J.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland.
  • Mosimann, Pascal J. University Institute of Diagnostic and Interventional Neuroradiology (J.K., E.I.P., P.J.M., P. Mordasini, T.D., J.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland.
  • Mordasini, Pasquale University Institute of Diagnostic and Interventional Neuroradiology (J.K., E.I.P., P.J.M., P. Mordasini, T.D., J.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland.
  • Goeldlin, Martina Department of Neurology (B.M., T.R.M., M.G., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland.
  • Arnold, Marcel Department of Neurology (B.M., T.R.M., M.G., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland.
  • Dobrocky, Tomas University Institute of Diagnostic and Interventional Neuroradiology (J.K., E.I.P., P.J.M., P. Mordasini, T.D., J.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland.
  • Boeckh-Behrens, Tobias Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Germany (T.B.-B., M.B.).
  • Berndt, Maria Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Germany (T.B.-B., M.B.).
  • Michel, Patrik Department of Neurology, CHUV Lausanne, Switzerland (P. Michel).
  • Requena, Manuel ORCID Department of Neurology, Vall d’Hebron University Hospital, Barcelona, Spain (M.R.).
  • Benali, Amel ORCID Department of Neuroradiology, CHU Montpellier, France (A. Benali).
  • Pierot, Laurent ORCID Department of Neuroradiology, CHU Reims, France (L.P.).
  • Mendes Pereira, Vitor Joint Department of Medical Imaging and Division of Neurosurgery, Toronto Western Hospital, University of Toronto, ON, Canada (V.M.P.).
  • Boulouis, Grégoire Department of Neuroradiology, Université Paris Descartes, Sainte Anne Hospital, France (G.B.).
  • Brehm, Alex ORCID Department of Neuroradiology (A. Brehm, P.B.S.), University Hospital Basel, Switzerland.
  • Sporns, Peter B. ORCID Department of Neuroradiology (A. Brehm, P.B.S.), University Hospital Basel, Switzerland.
  • Ospel, Johanna M. Department of Clinical Neuroscience, University of Calgary, Canada (J.M.O.).
  • Gralla, Jan University Institute of Diagnostic and Interventional Neuroradiology (J.K., E.I.P., P.J.M., P. Mordasini, T.D., J.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland.
  • Fischer, Urs ORCID Department of Neurology (B.M., T.R.M., M.G., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland.
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Published in:
  • Stroke. - Ovid Technologies (Wolters Kluwer Health). - 2020, vol. 51, no. 10, p. 2934-2942
English
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.

Language
  • English
Open access status
hybrid
Identifiers
Persistent URL
https://sonar.ch/global/documents/285576
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