Abstract 3582: Procedural Duration Impacts Clinical Outcome Following Intra-arterial Stroke Therapy
Background: Recanalization rates of large vessel occlusions (LVO) are higher with intra-arterial therapy (IAT) than with intravenous tPA. However, there are often time delays to IAT. Multiple pre- and intra-hospital factors impact on time from last seen well (LSW) to recanalization. We sought to compare standard time intervals prior to and during IAT to assess whether there is a differential influence on outcome in LVO.
Methods: We analyzed our prospective observational IAT database for patients with anterior circulation stroke undergoing IAT between February 2005 and November 2010. Times of LSW, imaging, groin puncture and recanalization were collected and analyzed. Functional outcome was assessed with 3 month modified Rankin scale (mRS), and was trichotomized into mild (mRS 0-2), moderate (mRS 3) and severe disability (mRS 4-6).
Results: Of 174 patients, 50% were female. Mean age was 63.7 years, median NIHSS 17. TICI 2-3 recanalization was strongly associated with improved outcome (p<0.0001), with recanalization occurring in all 43 patients with 3 month mRS 0-2. The time from groin puncture to recanalization had a strong impact on outcome (Figure). Among patients with mild, moderate and severe disability, the mean times were 93.4 minutes, 87.2 minutes, and 130.6 minutes, respectively (p=0.001). Time from baseline CT to recanalization was also associated with outcome: 211.9 minutes for mild, 213 minutes for moderate and 250 minutes for severe disability (p=0.036). Time intervals prior to imaging evaluation did not have a significant effect on outcome.
Conclusions: Acute stroke prognostication models should incorporate reliable and easily derived factors. Among patients selected for IAT using favorable imaging profiles, the time from groin puncture to recanalization is a strong predictor of 3 month outcome, and may be useful for early prognostication.
- © 2012 by American Heart Association, Inc.