Procedure duration predicts outcomes more than prehospital delay in endovascular stroke treatment.

IF 4.3 1区医学 Q1 NEUROIMAGING

Journal of NeuroInterventional Surgery Pub Date : 2025-09-19 DOI:10.1136/jnis-2025-023906

Hassan Saad, Andrew B Koo, Jonathan A Grossberg, Ma Tianwen, Brian M Howard, Mohammad-Mahdi Sowlat, Bachar El Baba, Ariana Chacon, Pascal Jabbour, Ansaar Rai, Justin Dye, Ali Alaraj, C Michael Cawley, Frank C Tong, Feras Akbik, Aqueel Pabaney, Mohamad Ezzeldin, David Fiorella, Shinichi Yoshimura, Joon-Tae Kim, Nitin Goyal, Adam S Arthur, Isabel Fragata, Fazeel M Siddiqui, Justin Mascitelli, Charles Matouk, Ilko Maier, Min S Park, Michael Levitt, Ramesh Grandhi, Marios-Nikos Psychogios, Stacey Q Wolfe, Robert M Starke, Amir Shaban, Edgar A Samaniego, Omar Tanweer, Daniele G Romano, Pedro Navia, Hugo H Cuellar, Adam J Polifka, Josh Osbun, Mark E Moss, Kaustubh Limaye, Maxim Mokin, Waleed Brinjikji, Ergun Daglioglu, Richard Williamson, David Altschul, Christopher S Ogilvy, Roberto Javier Crosa, Benjamin Gory, Alexandra R Paul, Peter Kan, Walter Casagrande, Shakeel A Chowdhry, Michael F Stiefel, Alejandro M Spiotta, Ali M Alawieh

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引用次数: 0

Abstract

Background: Endovascular thrombectomy (EVT) has transformed acute ischemic stroke (AIS) care, with onset-to-puncture (OTP) time widely recognized as a critical determinant of outcome. However, emerging evidence suggests that in-hospital procedure time (PT)-from arterial puncture to final recanalization-may have an equally or more significant impact. This study examines the relative contribution of PT versus OTP to functional outcomes in patients with AIS undergoing EVT.

Methods: A retrospective analysis was conducted of 6644 patients with AIS treated at 44 international stroke centers from the Stroke Thrombectomy and Aneurysm Registry (STAR; 2016-2023). Multivariable regression, time-equivalence analysis, and marginal effects modeling were used to assess associations between PT, OTP, and 90-day modified Rankin Scale (mRS) outcomes. Centers were stratified by procedural efficiency and compared using propensity score matching (PSM). Mediation analysis evaluated whether PT accounted for inter-center differences.

Results: PT and OTP were independently associated with functional outcomes; however, PT had a significantly stronger effect (adjusted OR for mRS 0-2: PT=0.56 vs OTP=0.96 per hour). Each 5 min increase in PT was equivalent to 78-100 min of additional OTP in outcome impact. Centers with faster average PT had higher rates of functional independence (number needed to treat (NNT)=10), fewer complications, and lower symptomatic intracranial hemorrhage rates. PT significantly mediated the relationship between center tier and outcomes (Sobel's P<0.001).

Conclusion: While minimizing OTP remains important, PT exerts a greater influence on outcomes after EVT. Procedural efficiency should be emphasized in stroke systems of care and included in center performance metrics to improve patient outcomes.

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手术时间比院前延迟更能预测血管内卒中治疗的预后。

背景：血管内血栓切除术（EVT）已经改变了急性缺血性卒中（AIS）的治疗方式，其中起病至穿刺（OTP）时间被广泛认为是预后的关键决定因素。然而，新出现的证据表明，从动脉穿刺到最终再通的住院手术时间（PT）可能具有同等或更重要的影响。本研究探讨了PT与OTP对AIS患者EVT功能结局的相对贡献。方法：回顾性分析来自44个国际卒中中心卒中血栓切除和动脉瘤登记（STAR; 2016-2023）的6644例AIS患者。采用多变量回归、时间等效分析和边际效应建模来评估PT、OTP和90天修正兰金量表（mRS）结果之间的相关性。中心按程序效率分层，并使用倾向评分匹配（PSM）进行比较。中介分析评估PT是否能解释中心间差异。结果：PT和OTP与功能结局独立相关；然而，PT的效果明显更强（mRS 0-2的调整OR: PT=0.56 vs OTP=0.96 /小时）。PT每增加5分钟，对结果的影响相当于额外的OTP 78-100分钟。平均PT更快的中心有更高的功能独立性（需要治疗的次数(NNT)=10），更少的并发症和更低的症状性颅内出血率。结论：虽然最小化OTP仍然很重要，但PT对EVT后的预后有更大的影响。在卒中护理系统中应强调程序效率，并将其纳入中心绩效指标，以改善患者预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of NeuroInterventional Surgery NEUROIMAGING-SURGERY

CiteScore

9.50

自引率

14.60%

发文量

291

审稿时长

4-8 weeks

期刊介绍： The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.