Fabrizio Sallustio, Alfredo Paolo Mascolo, Federico Marrama, Marina Diomedi, Giordano Lacidogna, Federica D'Agostino, Fana Alemseged, Valerio Da Ros, Federico Sabuzi, Enrico Fainardi, Ilaria Casetta, Stefano Vallone, Guido Bigliardi, Luca Allegretti, Elena Coco, Elvis Lafe, Marco Longoni, Vittorio Semeraro, Giovanni Boero, Benedetto Petralia, Manuel Cappellari, Ettore Nicolini, Antonio Ciacciarelli, Daniele Giuseppe Romano, Rosa Napoletano, Andrea Boghi, Andrea Naldi, Andrea Saletti, Alessandro De Vito, Sergio Lucio Vinci, Ludovica Ferraù, Domenico Sergio Zimatore, Marco Petruzzellis, Mauro Bergui, Giovanni Bosco, Ivan Gallesio, Delfina Ferrandi, Mirco Cosottini, Nicola Giannini, Alessio Comai, Elisa Dall'Ora, Giovanni Barchetti, Marcella Caggiula, Nicola Cavasin, Adriana Critelli, Marco Perri, Federica De Santis, Simone Galluzzo, Andrea Zini, Simone Zilahi De Gyurgyokai, Nicola Loizzo, Roberto Menozzi, Alessandro Pezzini, Massimo Sponza, Giovanni Merlino, Marco Filizzolo, Marina Mannino, Giuseppe Carità, Monia Russo, Massimiliano Allegritti, Stefano Caproni, Michele Besana, Alessia Giossi, Samuele Cioni, Rossana Tassi, Gianluca Galvano, Eleonora Saracco, Nicola Limbucci, Edoardo Puglielli, Alfonsina Casalena, Salvatore Mangiafico, Danilo Toni
{"title":"急性缺血性脑卒中患者接受静脉溶栓加机械取栓治疗后，从门到针的时间与预后之间的关系：来自意大利急性脑卒中血管内治疗登记处（IRETAS）的分析","authors":"Fabrizio Sallustio, Alfredo Paolo Mascolo, Federico Marrama, Marina Diomedi, Giordano Lacidogna, Federica D'Agostino, Fana Alemseged, Valerio Da Ros, Federico Sabuzi, Enrico Fainardi, Ilaria Casetta, Stefano Vallone, Guido Bigliardi, Luca Allegretti, Elena Coco, Elvis Lafe, Marco Longoni, Vittorio Semeraro, Giovanni Boero, Benedetto Petralia, Manuel Cappellari, Ettore Nicolini, Antonio Ciacciarelli, Daniele Giuseppe Romano, Rosa Napoletano, Andrea Boghi, Andrea Naldi, Andrea Saletti, Alessandro De Vito, Sergio Lucio Vinci, Ludovica Ferraù, Domenico Sergio Zimatore, Marco Petruzzellis, Mauro Bergui, Giovanni Bosco, Ivan Gallesio, Delfina Ferrandi, Mirco Cosottini, Nicola Giannini, Alessio Comai, Elisa Dall'Ora, Giovanni Barchetti, Marcella Caggiula, Nicola Cavasin, Adriana Critelli, Marco Perri, Federica De Santis, Simone Galluzzo, Andrea Zini, Simone Zilahi De Gyurgyokai, Nicola Loizzo, Roberto Menozzi, Alessandro Pezzini, Massimo Sponza, Giovanni Merlino, Marco Filizzolo, Marina Mannino, Giuseppe Carità, Monia Russo, Massimiliano Allegritti, Stefano Caproni, Michele Besana, Alessia Giossi, Samuele Cioni, Rossana Tassi, Gianluca Galvano, Eleonora Saracco, Nicola Limbucci, Edoardo Puglielli, Alfonsina Casalena, Salvatore Mangiafico, Danilo Toni","doi":"10.1177/23969873251368720","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>We aim to evaluate the association between door-to-needle time (DTN) and outcomes in a population of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) + mechanical thrombectomy (MT) in the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS).</p><p><strong>Materials and methods: </strong>Patients with AIS secondary to middle cerebral artery or intracranial internal carotid artery occlusion with known times of symptoms onset, directly presenting to an MT-capable center, were included in the analysis. According to pre-defined DTN cut-off values (⩽30, ⩽45, and ⩽60 min), we evaluated the association between DTN and outcomes by multivariate logistic regression analyses. Effectiveness outcomes were 3-month functional independence, 3-month excellent outcome and successful reperfusion. Safety outcomes were any intracranial hemorrhage (ICH), symptomatic intracerebral hemorrhage (sICH), and 3-month mortality.</p><p><strong>Results: </strong>About 1602 patients were included in our analysis. After logistic regression analysis, a DTN ⩽ 60 min was significantly associated with 3-month functional independence (OR 1.36; 95% CI 1.02-1.82). DTNs ⩽ 30, ⩽45, and ⩽60 min were significantly associated with successful reperfusion (OR 2.66; 95% CI 1.6-4.43; OR 1.68; 95%CI 1.25-2.26; OR 1.57; 95% CI 1.21-2.05; respectively). A DTN ⩽ 60 min was also significantly associated with lower rate of any ICH (OR 0.61; 95% CI 0.43-0.86). DTNs ⩽ 30, ⩽45, and ⩽60 min were significantly associated with lower 3-month mortality (OR 0.24; 95% CI 0.08-0.67; OR 0.45; 95% CI 0.29-0.72; OR 0.58; 95% CI 0.39-0.84; respectively).</p><p><strong>Conclusions: </strong>In patients with AIS treated with IVT + MT, a shorter DTN is associated with better outcomes if IVT is initiated within 1 h of hospital admission.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251368720"},"PeriodicalIF":4.5000,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12436340/pdf/","citationCount":"0","resultStr":"{\"title\":\"Association between door-to-needle time and outcomes in acute ischemic stroke patients treated with intravenous thrombolysis plus mechanical thrombectomy: Analysis from the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS).\",\"authors\":\"Fabrizio Sallustio, Alfredo Paolo Mascolo, Federico Marrama, Marina Diomedi, Giordano Lacidogna, Federica D'Agostino, Fana Alemseged, Valerio Da Ros, Federico Sabuzi, Enrico Fainardi, Ilaria Casetta, Stefano Vallone, Guido Bigliardi, Luca Allegretti, Elena Coco, Elvis Lafe, Marco Longoni, Vittorio Semeraro, Giovanni Boero, Benedetto Petralia, Manuel Cappellari, Ettore Nicolini, Antonio Ciacciarelli, Daniele Giuseppe Romano, Rosa Napoletano, Andrea Boghi, Andrea Naldi, Andrea Saletti, Alessandro De Vito, Sergio Lucio Vinci, Ludovica Ferraù, Domenico Sergio Zimatore, Marco Petruzzellis, Mauro Bergui, Giovanni Bosco, Ivan Gallesio, Delfina Ferrandi, Mirco Cosottini, Nicola Giannini, Alessio Comai, Elisa Dall'Ora, Giovanni Barchetti, Marcella Caggiula, Nicola Cavasin, Adriana Critelli, Marco Perri, Federica De Santis, Simone Galluzzo, Andrea Zini, Simone Zilahi De Gyurgyokai, Nicola Loizzo, Roberto Menozzi, Alessandro Pezzini, Massimo Sponza, Giovanni Merlino, Marco Filizzolo, Marina Mannino, Giuseppe Carità, Monia Russo, Massimiliano Allegritti, Stefano Caproni, Michele Besana, Alessia Giossi, Samuele Cioni, Rossana Tassi, Gianluca Galvano, Eleonora Saracco, Nicola Limbucci, Edoardo Puglielli, Alfonsina Casalena, Salvatore Mangiafico, Danilo Toni\",\"doi\":\"10.1177/23969873251368720\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>We aim to evaluate the association between door-to-needle time (DTN) and outcomes in a population of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) + mechanical thrombectomy (MT) in the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS).</p><p><strong>Materials and methods: </strong>Patients with AIS secondary to middle cerebral artery or intracranial internal carotid artery occlusion with known times of symptoms onset, directly presenting to an MT-capable center, were included in the analysis. 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引用次数: 0
摘要
在意大利急性卒中血管内治疗登记处（IRETAS）中，我们旨在评估接受静脉溶栓(IVT) +机械取栓（MT）治疗的急性缺血性卒中（AIS）患者的门到针时间（DTN）与预后之间的关系。材料和方法：已知症状发作时间的继发于大脑中动脉或颅内颈内动脉闭塞的AIS患者，直接到具有mt能力的中心就诊，纳入分析。根据预先定义的DTN截断值（≥30分钟，≥45分钟和≥60分钟），我们通过多变量逻辑回归分析评估DTN与预后之间的关系。疗效结果为3个月功能独立，3个月预后良好，再灌注成功。安全性指标为颅内出血（ICH）、症状性脑出血（sICH）和3个月死亡率。结果：约1602例患者纳入我们的分析。经logistic回归分析，DTN≥60 min与3个月功能独立性显著相关（OR 1.36; 95% CI 1.02-1.82）。dns≥30、≥45、≥60 min与再灌注成功相关（OR分别为2.66;95%CI 1.6-4.43; OR 1.68; 95%CI 1.25-2.26; OR 1.57; 95%CI 1.21-2.05）。DTN≤60 min也与较低的ICH发生率显著相关（OR 0.61; 95% CI 0.43-0.86）。dns≥30、≥45和≥60 min与较低的3个月死亡率显著相关（分别为OR 0.24; 95% CI 0.08-0.67; OR 0.45; 95% CI 0.29-0.72; OR 0.58; 95% CI 0.39-0.84）。结论：在接受IVT + MT治疗的AIS患者中，如果在入院后1小时内开始IVT，较短的DTN与较好的预后相关。
Association between door-to-needle time and outcomes in acute ischemic stroke patients treated with intravenous thrombolysis plus mechanical thrombectomy: Analysis from the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS).
Introduction: We aim to evaluate the association between door-to-needle time (DTN) and outcomes in a population of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) + mechanical thrombectomy (MT) in the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS).
Materials and methods: Patients with AIS secondary to middle cerebral artery or intracranial internal carotid artery occlusion with known times of symptoms onset, directly presenting to an MT-capable center, were included in the analysis. According to pre-defined DTN cut-off values (⩽30, ⩽45, and ⩽60 min), we evaluated the association between DTN and outcomes by multivariate logistic regression analyses. Effectiveness outcomes were 3-month functional independence, 3-month excellent outcome and successful reperfusion. Safety outcomes were any intracranial hemorrhage (ICH), symptomatic intracerebral hemorrhage (sICH), and 3-month mortality.
Results: About 1602 patients were included in our analysis. After logistic regression analysis, a DTN ⩽ 60 min was significantly associated with 3-month functional independence (OR 1.36; 95% CI 1.02-1.82). DTNs ⩽ 30, ⩽45, and ⩽60 min were significantly associated with successful reperfusion (OR 2.66; 95% CI 1.6-4.43; OR 1.68; 95%CI 1.25-2.26; OR 1.57; 95% CI 1.21-2.05; respectively). A DTN ⩽ 60 min was also significantly associated with lower rate of any ICH (OR 0.61; 95% CI 0.43-0.86). DTNs ⩽ 30, ⩽45, and ⩽60 min were significantly associated with lower 3-month mortality (OR 0.24; 95% CI 0.08-0.67; OR 0.45; 95% CI 0.29-0.72; OR 0.58; 95% CI 0.39-0.84; respectively).
Conclusions: In patients with AIS treated with IVT + MT, a shorter DTN is associated with better outcomes if IVT is initiated within 1 h of hospital admission.
期刊介绍：
Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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