TY - JOUR
T1 - Earlier Endovascular Thrombectomy and Mortality in Patients with Anterior Circulation Large Vessel Occlusion
T2 - A Propensity-Matched Analysis of the Stroke Thrombectomy and Aneurysm Registry
AU - Stroke Thrombectomy and Aneurysm Registry (STAR) Collaborators
AU - Matsukawa, Hidetoshi
AU - Crosa, Roberto
AU - Cunningham, Conor
AU - Maier, Ilko
AU - Al Kasab, Sami
AU - Jabbour, Pascal
AU - Kim, Joon Tae
AU - Wolfe, Stacey Quintero
AU - Rai, Ansaar
AU - Starke, Robert M.
AU - Psychogios, Marios Nikos
AU - Shaban, Amir
AU - Goyal, Nitin
AU - Yoshimura, Shinichi
AU - Cuellar, Hugo
AU - Howard, Brian
AU - Alawieh, Ali
AU - Alaraj, Ali
AU - Ezzeldin, Mohamad
AU - Romano, Daniele G.
AU - Tanweer, Omar
AU - Mascitelli, Justin
AU - Fragata, Isabel
AU - Polifka, Adam
AU - Siddiqui, Fazeel
AU - Osbun, Joshua
AU - Matouk, Charles
AU - Park, Min S.
AU - Levitt, Michael R.
AU - Brinjikji, Waleed
AU - Moss, Mark
AU - Williamson, Richard
AU - Navia, Pedro
AU - Kan, Peter
AU - Leacy, Reade De
AU - Chowdhry, Shakeel
AU - Spiotta, Alejandro M.
N1 - Publisher Copyright:
© 2024 Elsevier Inc.
PY - 2024/9
Y1 - 2024/9
N2 - Background: The definitive impact of onset to arterial puncture time (OPT) on 90-day mortality after endovascular thrombectomy (EVT) in patients with acute ischemic stroke (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. Methods: 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 postprocedure modified Thrombolysis in Cerebral Infarction scale ≥2b), and intracranial hemorrhage. Results: A total of 2842 AIS-LVO patients with EVT were included. The cutoff for OPT for 90-day mortality was 180 min. Of these 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. Conclusions: 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.
AB - Background: The definitive impact of onset to arterial puncture time (OPT) on 90-day mortality after endovascular thrombectomy (EVT) in patients with acute ischemic stroke (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. Methods: 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 postprocedure modified Thrombolysis in Cerebral Infarction scale ≥2b), and intracranial hemorrhage. Results: A total of 2842 AIS-LVO patients with EVT were included. The cutoff for OPT for 90-day mortality was 180 min. Of these 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. Conclusions: 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.
KW - Large vessel occlusion
KW - Mechanical thrombectomy
KW - Mortality
KW - Onset to puncture time
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U2 - 10.1016/j.wneu.2024.06.082
DO - 10.1016/j.wneu.2024.06.082
M3 - Article
C2 - 38908685
AN - SCOPUS:85199434989
SN - 1878-8750
VL - 189
SP - e435-e441
JO - World Neurosurgery
JF - World Neurosurgery
ER -