Comprehensive analysis of the impact of procedure time and the 'golden hour' in subpopulations of stroke thrombectomy patients.

IF 4.5 1区医学 Q1 NEUROIMAGING

Journal of NeuroInterventional Surgery Pub Date : 2024-10-14 DOI:10.1136/jnis-2023-020792

Makenna Ash, Laurie Dimisko, Reda M Chalhoub, Brian M Howard, C Michael Cawley, Charles Matouk, Aqueel Pabaney, Alejandro M Spiotta, Pascal Jabbour, Ilko Maier, Stacey Q Wolfe, Ansaar T Rai, Joon-Tae Kim, Marios-Nikos Psychogios, Justin R Mascitelli, Robert M Starke, Amir Shaban, Shinichi Yoshimura, Reade De Leacy, Peter Kan, Isabel Fragata, Adam J Polifka, Adam S Arthur, Min S Park, Roberto Javier Crosa, Richard Williamson, Travis M Dumont, Michael R Levitt, Sami Al Kasab, Stavropoula I Tjoumakaris, Jan Liman, Hassan Saad, Edgar A Samaniego, Kyle M Fargen, Jonathan A Grossberg, Ali Alawieh

{"title":"Comprehensive analysis of the impact of procedure time and the 'golden hour' in subpopulations of stroke thrombectomy patients.","authors":"Makenna Ash, Laurie Dimisko, Reda M Chalhoub, Brian M Howard, C Michael Cawley, Charles Matouk, Aqueel Pabaney, Alejandro M Spiotta, Pascal Jabbour, Ilko Maier, Stacey Q Wolfe, Ansaar T Rai, Joon-Tae Kim, Marios-Nikos Psychogios, Justin R Mascitelli, Robert M Starke, Amir Shaban, Shinichi Yoshimura, Reade De Leacy, Peter Kan, Isabel Fragata, Adam J Polifka, Adam S Arthur, Min S Park, Roberto Javier Crosa, Richard Williamson, Travis M Dumont, Michael R Levitt, Sami Al Kasab, Stavropoula I Tjoumakaris, Jan Liman, Hassan Saad, Edgar A Samaniego, Kyle M Fargen, Jonathan A Grossberg, Ali Alawieh","doi":"10.1136/jnis-2023-020792","DOIUrl":null,"url":null,"abstract":"Objective: To evaluate the effect of procedure time on thrombectomy outcomes in different subpopulations of patients undergoing endovascular thrombectomy (EVT), given the recently expanded indications for EVT.Methods: This multicenter study included patients undergoing EVT for acute ischemic stroke at 35 centers globally. Procedure time was defined as time from groin puncture to successful recanalization (Thrombolysis in Cerebral Infarction score ≥2b) or abortion of procedure. Patients were stratified based on stroke location, use of IV tissue plasminogen activator (tPA), Alberta Stroke Program Early CT score, age group, and onset-to-groin time. Primary outcome was the 90-day modified Rankin Scale (mRS) score, with scores 0-2 designating good outcome. Secondary outcome was postprocedural symptomatic intracranial hemorrhage (sICH). Multivariate analyses were performed using generalized linear models to study the impact of procedure time on outcomes in each subpopulation.Results: Among 8961 patients included in the study, a longer procedure time was associated with higher odds of poor outcome (mRS score 3-6), with 10% increase in odds for each 10 min increment. When procedure time exceeded the 'golden hour', poor outcome was twice as likely. The golden hour effect was consistent in patients with anterior and posterior circulation strokes, proximal or distal occlusions, in patients with large core infarcts, with or without IV tPA treatment, and across age groups. Procedures exceeding 1 hour were associated with a 40% higher sICH rate. Posterior circulation strokes, delayed presentation, and old age were the variables most sensitive to procedure time.Conclusions: In this work we demonstrate the universality of the golden hour effect, in which procedures lasting more than 1 hour are associated with worse clinical outcomes and higher rates of sICH across different subpopulations of patients undergoing EVT.","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":null,"pages":null},"PeriodicalIF":4.5000,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of NeuroInterventional Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/jnis-2023-020792","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NEUROIMAGING","Score":null,"Total":0}

引用次数: 0

Abstract

Objective: To evaluate the effect of procedure time on thrombectomy outcomes in different subpopulations of patients undergoing endovascular thrombectomy (EVT), given the recently expanded indications for EVT.

Methods: This multicenter study included patients undergoing EVT for acute ischemic stroke at 35 centers globally. Procedure time was defined as time from groin puncture to successful recanalization (Thrombolysis in Cerebral Infarction score ≥2b) or abortion of procedure. Patients were stratified based on stroke location, use of IV tissue plasminogen activator (tPA), Alberta Stroke Program Early CT score, age group, and onset-to-groin time. Primary outcome was the 90-day modified Rankin Scale (mRS) score, with scores 0-2 designating good outcome. Secondary outcome was postprocedural symptomatic intracranial hemorrhage (sICH). Multivariate analyses were performed using generalized linear models to study the impact of procedure time on outcomes in each subpopulation.

Results: Among 8961 patients included in the study, a longer procedure time was associated with higher odds of poor outcome (mRS score 3-6), with 10% increase in odds for each 10 min increment. When procedure time exceeded the 'golden hour', poor outcome was twice as likely. The golden hour effect was consistent in patients with anterior and posterior circulation strokes, proximal or distal occlusions, in patients with large core infarcts, with or without IV tPA treatment, and across age groups. Procedures exceeding 1 hour were associated with a 40% higher sICH rate. Posterior circulation strokes, delayed presentation, and old age were the variables most sensitive to procedure time.

Conclusions: In this work we demonstrate the universality of the golden hour effect, in which procedures lasting more than 1 hour are associated with worse clinical outcomes and higher rates of sICH across different subpopulations of patients undergoing EVT.

查看原文本刊更多论文

手术时间和“黄金时间”对脑卒中取栓患者亚群影响的综合分析。

目的：鉴于血管内血栓切除术（EVT）的适应症最近有所扩大，评估手术时间对不同亚群接受腔内血栓切除术患者血栓切除结果的影响。方法：这项多中心研究纳入了全球35个中心接受EVT治疗急性缺血性脑卒中的患者。手术时间定义为从腹股沟穿刺到成功再通（脑梗死溶栓评分≥2b）或手术流产的时间。根据卒中部位、静脉注射组织纤溶酶原激活剂（tPA）的使用、艾伯塔省卒中计划早期CT评分、年龄组和发病至腹股沟时间对患者进行分层。主要结果是90天改良兰金量表（mRS）评分，评分0-2表示良好结果。次要转归为硬膜后症状性颅内出血（sICH）。使用广义线性模型进行多变量分析，以研究每个亚群中手术时间对结果的影响。结果：在纳入研究的8961名患者中，手术时间越长，不良结果的几率越高（mRS评分3-6），每10名患者的几率增加10% 最小增量。当手术时间超过“黄金时段”时，不良结果的可能性是原来的两倍。在前循环和后循环卒中、近端或远端闭塞的患者、大核心梗死的患者、接受或不接受静脉注射tPA治疗的患者以及不同年龄组中，黄金时段效应是一致的。程序超过1 小时与sICH发生率高出40%相关。后循环卒中、迟发和老年是对手术时间最敏感的变量。结论：在这项工作中，我们证明了黄金时段效应的普遍性，在黄金时段效应中，手术持续时间超过1 在接受EVT的不同亚群中，小时与更差的临床结果和更高的sICH发生率相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

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.