Microcatheter to recanalization (procedure time) predicts outcomes in endovascular treatment in patients with acute ischemic stroke: when do we stop?

AJNR Am J Neuroradiol. 2013 Feb;34(2):354-9. doi: 10.3174/ajnr.A3202. Epub 2012 Jul 19.

Abstract

Background and purpose: Endovascular treatment for acute ischemic stroke consists of various mechanical and pharmacologic modalities used for recanalization of arterial occlusions. We performed this study to determine the relationship among procedure time, recanalization, and clinical outcomes in patients with acute ischemic stroke undergoing endovascular treatment.

Materials and methods: We analyzed data from consecutive patients with acute ischemic stroke who underwent endovascular treatment during a 6-year period. Demographic characteristics, NIHSS score before and 24 hours after the procedure, and discharge mRS score were ascertained. Procedure time was defined by the time interval between microcatheter placement and recanalization or completion of the procedure. We estimated the procedure time after which favorable clinical outcome was unlikely, even after adjustment for age, time from symptom onset, and admission NIHSS scores.

Results: We analyzed 209 patients undergoing endovascular treatment (mean age, 65 ± 16 years; 109 [52%] men; mean admission/preprocedural NIHSS score, 15.3 ± 6.8). Complete or partial recanalization was observed in 176 (84.2%) patients, while unfavorable outcome (mRS 3-6) was observed in 138 (66%) patients at discharge. In univariate analysis, patients with procedure time ≤30 minutes had lower rates of unfavorable outcome at discharge compared with patients with procedure time ≥30 minutes (52.3% versus 72.2%, P = .0049). In our analysis, the rates of favorable outcomes in endovascularly treated patients after 60 minutes were lower than rates observed with placebo treatment in the Prourokinase for Acute Ischemic Stroke Trial. In logistic regression analysis, unfavorable outcome was positively associated with age (P = .0012), admission NIHSS strata (P = .0017), and longer procedure times (P = .0379).

Conclusions: Procedure time in patients with acute ischemic stroke appears to be a critical determinant of outcomes following endovascular treatment. This highlights the need for procedure time guidelines for patients being considered for endovascular treatment in acute ischemic stroke.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Brain Ischemia / drug therapy*
  • Brain Ischemia / epidemiology
  • Brain Ischemia / surgery
  • Cerebral Revascularization / methods*
  • Cerebral Revascularization / statistics & numerical data
  • Databases, Factual
  • Endovascular Procedures / methods*
  • Endovascular Procedures / statistics & numerical data
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Humans
  • Male
  • Mechanical Thrombolysis / methods
  • Mechanical Thrombolysis / statistics & numerical data
  • Middle Aged
  • Multivariate Analysis
  • Practolol
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Factors
  • Stroke / drug therapy*
  • Stroke / epidemiology
  • Stroke / surgery
  • Thrombolytic Therapy / methods
  • Time Factors
  • Tissue Plasminogen Activator / administration & dosage
  • Treatment Outcome
  • Vascular Access Devices*

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator
  • Practolol