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":"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。","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":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":"1069-1075"},"PeriodicalIF":4.5000,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"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\":\"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":16411,\"journal\":{\"name\":\"Journal of NeuroInterventional Surgery\",\"volume\":\" \",\"pages\":\"1069-1075\"},\"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}","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}
Comprehensive analysis of the impact of procedure time and the 'golden hour' in subpopulations of stroke thrombectomy patients.
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.
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.
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