Earlier endovascular thrombectomy and mortality in patients with anterior circulation large vessel occlusion: a propensity-matched analysis of the Stroke Thrombectomy and Aneurysm Registry (STAR)

Hidetoshi Matsukawa; Roberto Crosa; Conor Cunningham; Ilko Maier; Sami Al Kasab; Pascal Jabbour; Joon-Tae Kim; Stacey Quintero Wolfe; Ansaar Rai; Robert M Starke; Marios-Nikos Psychogios; Amir Shaban; Nitin Goyal; Shinichi Yoshimura; Hugo Cuellar; Brian Howard; Ali Alawieh; Ali Alaraj; Mohamad Ezzeldin; Daniele G Romano; Omar Tanweer; Justin Mascitelli; Isabel Fragata; Adam Polifka; Fazeel Siddiqui; Joshua Osbun; Charles Matouk; Min S Park; Michael R Levitt; Waleed Brinjikji; Mark Moss; Richard Williamson; Pedro Navia; Peter Kan; Reade De Leacy; Shakeel Chowdhry; Alejandro M Spiotta

doi:10.1016/j.wneu.2024.06.082

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Earlier endovascular thrombectomy and mortality in patients with anterior circulation large vessel occlusion: a propensity-matched analysis of the Stroke Thrombectomy and Aneurysm Registry (STAR)

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Earlier endovascular thrombectomy and mortality in patients with anterior circulation large vessel occlusion: a propensity-matched analysis of the Stroke Thrombectomy and Aneurysm Registry (STAR)

Hidetoshi Matsukawa, Roberto Crosa, Conor Cunningham, Ilko Maier, Sami Al Kasab, Pascal Jabbour, Joon-Tae Kim, Stacey Quintero Wolfe, Ansaar Rai, Robert M Starke, …

World neurosurgery, Vol.189, pp.e435-e441

06/20/2024

DOI: 10.1016/j.wneu.2024.06.082

PMID: 38908685

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https://resolver.sub.uni-goettingen.de/purl?gro-2/144125View

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Abstract

The definitive impact of onset to arterial puncture time (OPT) on 90-day mortality after endovascular thrombectomy (EVT) in patients with acute cerebral infarction (AIS) caused by anterior circulation large vessel occlusion (LVO) remains unknown. The present study aimed to evaluate the influence of OPT on 90-day mortality in anterior circulation AIS-LVO patients who underwent EVT.BACKGROUNDThe definitive impact of onset to arterial puncture time (OPT) on 90-day mortality after endovascular thrombectomy (EVT) in patients with acute cerebral infarction (AIS) caused by anterior circulation large vessel occlusion (LVO) remains unknown. The present study aimed to evaluate the influence of OPT on 90-day mortality in anterior circulation AIS-LVO patients who underwent EVT.Data from 33 international centers were retrospectively analyzed. The receiver operating characteristic curve analysis was used to identify a cutoff for OPT. A propensity score-matched analysis was performed. The primary outcome was 90-day mortality (modified Rankin Scale [mRS] 6). Secondary outcomes included mortality at discharge, 90-day good outcome (mRS 0-2), 90-day poor outcome (mRS 5-6), successful recanalization (defined as post-procedure modified Thrombolysis in Cerebral Infarction scale ≥2b), and intracranial hemorrhage.METHODSData from 33 international centers were retrospectively analyzed. The receiver operating characteristic curve analysis was used to identify a cutoff for OPT. A propensity score-matched analysis was performed. The primary outcome was 90-day mortality (modified Rankin Scale [mRS] 6). Secondary outcomes included mortality at discharge, 90-day good outcome (mRS 0-2), 90-day poor outcome (mRS 5-6), successful recanalization (defined as post-procedure modified Thrombolysis in Cerebral Infarction scale ≥2b), and intracranial hemorrhage.2,842 AIS-LVO patients with EVT were included. The cutoff for OPT for 90-day mortality was 180 min. 378 patients had OPT < 180 min and 378 patients had OPT ≥ 180 min in the propensity score-matched cohort (n=756). Patients with OPT < 180 min were less likely to have 90-day mortality (odds ratio [OR] 0.70, 95% confidence interval [CI] 0.51-0.96) and poor outcome (OR 0.71, 95% CI 0.53-0.96), and more likely to have 90-day good outcome (OR 1.55, 95% CI 1.16-2.08). Other outcomes showed no significant differences.RESULTS2,842 AIS-LVO patients with EVT were included. The cutoff for OPT for 90-day mortality was 180 min. 378 patients had OPT < 180 min and 378 patients had OPT ≥ 180 min in the propensity score-matched cohort (n=756). Patients with OPT < 180 min were less likely to have 90-day mortality (odds ratio [OR] 0.70, 95% confidence interval [CI] 0.51-0.96) and poor outcome (OR 0.71, 95% CI 0.53-0.96), and more likely to have 90-day good outcome (OR 1.55, 95% CI 1.16-2.08). Other outcomes showed no significant differences.This study showed that OPT < 180 min was less related to 90-day mortality and poor outcome, and more to 90-day good outcome in AIS-LVO patients who underwent EVT.CONCLUSIONSThis study showed that OPT < 180 min was less related to 90-day mortality and poor outcome, and more to 90-day good outcome in AIS-LVO patients who underwent EVT.

Large vessel occlusion

Mechanical thrombectomy

Mortality

Onset to puncture time

Details

Title: Subtitle: Earlier endovascular thrombectomy and mortality in patients with anterior circulation large vessel occlusion: a propensity-matched analysis of the Stroke Thrombectomy and Aneurysm Registry (STAR)
Creators: Hidetoshi Matsukawa - Medical University of South Carolina
Roberto Crosa
Conor Cunningham - Medical University of South Carolina
Ilko Maier - Universitätsmedizin Göttingen
Sami Al Kasab - Medical University of South Carolina
Pascal Jabbour - Jefferson University Hospitals
Joon-Tae Kim - Chonnam National University Hospital
Stacey Quintero Wolfe - Wake Forest University
Ansaar Rai
Robert M Starke - University of Miami Health System
Marios-Nikos Psychogios
Amir Shaban - University of Iowa
Nitin Goyal - Semmes Murphey Foundation
Shinichi Yoshimura - Hyogo University
Hugo Cuellar - Louisiana State University in Shreveport
Brian Howard - Emory University
Ali Alawieh - Emory University
Ali Alaraj - University of Illinois Chicago
Mohamad Ezzeldin - University of Houston
Daniele G Romano - Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona
Omar Tanweer
Justin Mascitelli
Isabel Fragata
Adam Polifka
Fazeel Siddiqui
Joshua Osbun
Charles Matouk
Min S Park
Michael R Levitt
Waleed Brinjikji
Mark Moss
Richard Williamson
Pedro Navia
Peter Kan
Reade De Leacy
Shakeel Chowdhry
Alejandro M Spiotta
Resource Type: Journal article
Publication Details: World neurosurgery, Vol.189, pp.e435-e441
DOI: 10.1016/j.wneu.2024.06.082
PMID: 38908685
NLM abbreviation: World Neurosurg
ISSN: 1878-8769
eISSN: 1878-8769
Publisher: ELSEVIER SCIENCE INC
Grant note: Swiss National Science Foundation (SNF): 33IC30_198783, 32003B_204977 Contact PI for NIH: R21NS128641 NIH: 1U18EB029353-01, UG3NS128397
Health and Health Disparities. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. RMS has an unrestricted research grant from Medtronic and Balt and has consulting and teaching agreements with Penumbra, Abbott, Medtronic, Balt, InNeuroCo, Cerenovus, Naglreiter, Tonbridge, Von Medical, and Optimize Vascular. M. Psychogios received grants from the Swiss National Science Foundation (SNF) for the DISTAL trial (33IC30_198783) and TECNO trial (32003B_204977) , Grant from Bangerter-Rhyner Stiftung for the DISTAL trial. Unrestricted Grants for the DISTAL trial from Stryker Neurovascular Inc., Phenox GmbH, Penumbra Inc. and Rapid Medical Inc., Sponsor-PI SPINNERS trial (Funded by a Siemens Healthineers AG Grant) , Research agreement with Siemens Healthineers AG, Local PI for the ASSIST, EXCELLENT, TENSION, COATING, SURF and ESCAPE-NEXT trials. Speaker fees: Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Siemens Healthineers AG. S. Yoshimura received a lecture fee from Stryker, Medtronic, Johnson & Johnson, Kaneka Medics. H. Cuellar is a consultant for Medtronic, Penumbra, and Microvention. M. Ezzeldin is a speaker for Viz.ai and has stocks in Galaxy Therapeutics. D. Romano is a consultant for Penumbra, Balt, Microvention, and Phenox. C. Matouk is a consultant for Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical. They are also a speaker for Penumbra and Silk Road Medical. Contact PI for NIH Grant R21NS128641. M. Park is a consultant for Medtronic. M. Levitt: Stryker and Medtronic. They have equity interest in Synchron, Stroke Diagnostics, Hyperion Surgical, Proprio, Apertur. They also have financial interest in Fluid Biomed. They are also a consultant for Aeaean Advisers, Metis Innovative, and Stereotaxis. They also serve on the editorial board for Frontiers in Surgery and Journal of NeuroInterventional Surgery (JNIS) and on the Data safety monitoring board for Arsenal Medical. R. Williamson is a consultant for Medtronic, Stryker, and Synaptive Medical.P. Navia is a consultant for Penumbra, Medtronic, Stryker, Cerenovus, and Balt. P. Kan received grants from the NIH (1U18EB029353-01, UG3NS128397) and unrestricted educational grant from Siemens. They are also a consultant for Stryker Neurovascular. They have stock ownership in Vena Medical, Deinde, Prometheus, Neurofine, and Vented. They also serve on the editorial board for the Journal of Neurointerventional Surgery (JNIS) . R. Leacy received research grants from Siemens Healthineers and Kaneka medical. They are also a consultant for Cerenovus, Stryker Neurovascular, and Scientia Vascular. They also own minor equity interest Vastrax, Borvo medical, Synchron, Endostream, Von Vascular. S. Chowdhry is a consultant and proctor for Medtronic and Microvention. A. Spiotta received research support from Penumbra, Stryker, Medtronic, and RapidAI. They are also a consultant for Penumbra, Stryker, Terumo, and RapidAI. The remaining authors have no conflicts to report.
Language: English
Electronic publication date: 06/20/2024
Academic Unit: Neurology
Record Identifier: 9984643753602771

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