Time from stroke onset to groin puncture affects rate of recanalisation after mechanical thrombectomy: a real-life single centre experience
, 2, 1, 2, 1, 1
Abstract
Aim of the study. We investigated whether the time elapsed between stroke onset and groin puncture (SO-GP) affects the rate of recanalisation as measured by the Thrombolysis in Cerebral Infarction (TICI) scale.
Clinical rationale for the study. There is no doubt that the effectiveness of thrombolysis in acute ischaemic stroke (AIS) is time-dependent. There is growing evidence that there is a correlation between SO-GP time and rate of recanalisation in patients treated by mechanical thrombectomy (MT).
Materials and methods. This study was performed in patients treated in the Comprehensive Stroke Centre in Krakow that covers 3.5 million inhabitants. The following data was collected for this study: demographics, stroke risk factors, transportation (directly from home or via another hospital), admission NIHSS, IV rt-PA administration prior to MT, the number of passes used during MT, and SO-GP time. The favourable outcome measure was TICI 2b or 3.
Results. 223 patients (48.4% females; mean age: 66.0 ± 16.6 years) with anterior circulation strokes were treated by MT; 64.6% arrived directly from home. Mean admission NIHSS was 15.6 ± 5.3. IV rtPA was administered in 68.6% of patients. At least two thrombectomy passes were required in 20.6% of cases. Median SO-GP time was 240 minutes (IQR range: 180–305 minutes). Grade 3 or 2b TICI scores were obtained in 70.4% of patients. Univariate logistic regression showed that among all studied parameters, only NIHSS affected the rate of recanalisation, but in a multivariate logistic regression model, the only parameter that affected the rate of recanalisation was the SO-GP time (OR = 0.76; 95% CI: 0.60-0.98, p = 0.03).
Conclusions and clinical implications. We suggest that SO-GP time affects the rate of recanalisation in patients with MT.
Keywords: strokethrombectomyischaemic stroketimerecanalisationgroin puncture
References
- Lambrinos A, Schaink AK, Dhalla I, et al. Mechanical Thrombectomy in Acute Ischemic Stroke: A Systematic Review. Can J Neurol Sci. 2016; 43(4): 455–460.
- Alcock S, Sawatzky JAV. "Time is Brain:" A concept anaiysis. Can J Neurosci Nurs. 2016; 38(2): 5–11.
- Bourcier R, Goyal M, Liebeskind DS, et al. HERMES Trialists Collaboration. Association of Time From Stroke Onset to Groin Puncture With Quality of Reperfusion After Mechanical Thrombectomy: A Meta-analysis of Individual Patient Data From 7 Randomized Clinical Trials. JAMA Neurol. 2019; 76(4): 405–411.
- Spiotta AM, Vargas J, Turner R, et al. The golden hour of stroke intervention: effect of thrombectomy procedural time in acute ischemic stroke on outcome. J Neurointerv Surg. 2014; 6(7): 511–516.
- Fransen P, Berkhemer O, Lingsma H, et al. Time to Reperfusion and Treatment Effect for Acute Ischemic Stroke. JAMA Neurology. 2016; 73(2): 190.
- Ribo M, Molina CA, Cobo E, et al. REVASCAT Trial Investigators. Association Between Time to Reperfusion and Outcome Is Primarily Driven by the Time From Imaging to Reperfusion. Stroke. 2016; 47(4): 999–1004.
- Hassan AE, Shariff U, Saver JL, et al. Impact of procedural time on clinical and angiographic outcomes in patients with acute ischemic stroke receiving endovascular treatment. J Neurointerv Surg. 2019; 11(10): 984–988.
- Goyal M, Jadhav AP, Bonafe A, et al. SWIFT PRIME investigators. Analysis of Workflow and Time to Treatment and the Effects on Outcome in Endovascular Treatment of Acute Ischemic Stroke: Results from the SWIFT PRIME Randomized Controlled Trial. Radiology. 2016; 279(3): 888–897.
- Ozdemir O, Giray S, Arlier Z, et al. Predictors of a Good Outcome after Endovascular Stroke Treatment with Stent Retrievers. ScientificWorldJournal. 2015; 2015: 403726.
- Khatri P, Yeatts SD, Mazighi M, et al. IMS III Trialists. Time to angiographic reperfusion and clinical outcome after acute ischaemic stroke: an analysis of data from the Interventional Management of Stroke (IMS III) phase 3 trial. Lancet Neurol. 2014; 13(6): 567–574.
- Nogueira RG, Smith WS, Sung G, et al. MERCI and Multi MERCI Writing Committee. Effect of time to reperfusion on clinical outcome of anterior circulation strokes treated with thrombectomy: pooled analysis of the MERCI and Multi MERCI trials. Stroke. 2011; 42(11): 3144–3149.
- Starostka-Tatar A, Łabuz-Roszak B, Skrzypek M, et al. [Definition and treatment of stroke over the centuries]. Wiad Lek. 2017; 70(5): 982–987.
- Rödén-Jüllig A, Britton M, Gustafsson C, et al. Validation of four scales for the acute stage of stroke. J Intern Med. 1994; 236(2): 125–136.
- Fugate JE, Klunder AM, Kallmes DF. What is meant by "TICI"? AJNR Am J Neuroradiol. 2013; 34(9): 1792–1797.
- Neuberger U, Möhlenbruch MA, Herweh C, et al. Classification of Bleeding Events: Comparison of ECASS III (European Cooperative Acute Stroke Study) and the New Heidelberg Bleeding Classification. Stroke. 2017; 48(7): 1983–1985.
- Sulter G, Steen C, De Keyser J. Use of the Barthel index and modified Rankin scale in acute stroke trials. Stroke. 1999; 30(8): 1538–1541.
- Yaghi S, Willey JZ, Cucchiara B, et al. American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Council on Quality of Care and Outcomes Research. Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2017; 48(12): e343–e361.
- Sun CHJ, Ribo M, Goyal M, et al. Door-to-puncture: a practical metric for capturing and enhancing system processes associated with endovascular stroke care, preliminary results from the rapid reperfusion registry. J Am Heart Assoc. 2014; 3(2): e000859.
- Sun CHJ, Nogueira RG, Glenn BA, et al. "Picture to puncture": a novel time metric to enhance outcomes in patients transferred for endovascular reperfusion in acute ischemic stroke. Circulation. 2013; 127(10): 1139–1148.
- Saver JL, Goyal M, van der Lugt A, et al. HERMES Collaborators. Time to Treatment With Endovascular Thrombectomy and Outcomes From Ischemic Stroke: A Meta-analysis. JAMA. 2016; 316(12): 1279–1288.
