Journal article
Comprehensive analysis of the impact of procedure time and the ‘golden hour’ in subpopulations of stroke thrombectomy patients
Journal of neurointerventional surgery, Vol.16(11), pp.1069-1075
11/2024
DOI: 10.1136/jnis-2023-020792
PMID: 37875342
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.
Details
- Title: Subtitle
- Comprehensive analysis of the impact of procedure time and the ‘golden hour’ in subpopulations of stroke thrombectomy patients
- Creators
- Makenna Ash - Emory UniversityLaurie Dimisko - Emory HealthcareReda Chalhoub - Medical University of South CarolinaBrian Howard - Emory UniversityC CawleyCharles Matouk - Yale UniversityAqueel Pabaney - Grady Memorial HospitalAlejandro Spiotta - Medical University of South CarolinaPascal Jabbour - Thomas Jefferson University HospitalIlko MaierStacey Wolfe - Wake Forest UniversityAnsaar Rai - West Virginia UniversityJoon-Tae KimMarios-Nikos Psychogios - University Hospital of BaselJustin Mascitelli - The University of Texas Health Science Center at San AntonioRobert Starke - University of MiamiAmir Shaban - University of IowaShinichi Yoshimura - Hyogo Medical UniversityReade De Leacy - Icahn School of Medicine at Mount SinaiPeter Kan - The University of Texas Medical Branch at GalvestonIsabel Fragata - Unidade Local de Saúde de São JoséAdam Polifka - University of FloridaAdam Arthur - University of Tennessee Health Science CenterMin Park - Barrow Neurological InstituteRoberto CrosaRichard Williamson - Baptist Medical Center JacksonvilleTravis Dumont - University of ArizonaMichael Levitt - University of WashingtonSami Al Kasab - Medical University of South CarolinaStavropoula Tjoumakaris - Thomas Jefferson University HospitalJan LimanHassan Saad - Emory UniversityEdgar Samaniego - University of IowaKyle Fargen - Wake Forest UniversityJonathan Grossberg - Emory UniversityAli Alawieh - Emory University
- Resource Type
- Journal article
- Publication Details
- Journal of neurointerventional surgery, Vol.16(11), pp.1069-1075
- DOI
- 10.1136/jnis-2023-020792
- PMID
- 37875342
- NLM abbreviation
- J Neurointerv Surg
- ISSN
- 1759-8478
- eISSN
- 1759-8486
- Publisher
- BMJ Publishing Group LTD
- Language
- English
- Electronic publication date
- 10/24/2023
- Date published
- 11/2024
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984500083002771
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