Abstract TP4: How Long is Too Long: The Effect of Thrombectomy Procedure Duration on Outcome in Revascularized SWIFT Trial Patients
Introduction: Thrombectomy procedure start time to recanalization has been may be an important predictor of clinical outcome following endovascular therapy of acute ischemic stroke (AIS) patients. In this study, we sought to assess the impact of groin puncture time to revascularization (procedure duration) on outcomes in the multicenter, randomized Solitaire FR with the Intention for Thrombectomy (SWIFT) trial.
Methods: AIS patients enrolled in the SWIFT trial who achieved the primary endpoint of successful recanalization without hemorrhage (SR-sICH) were included. The procedure duration (PD) was defined as time from groin puncture to revascularization. The PD was the main predictor variable. The main outcome variables were the 90 days modified Rankin’s Scale (mRS)≤2; good neurologic outcome (Rankin’s Scale (mRS)≤2 or NIHSS Improvement of≥0), and mortality. Patient demographic, clinical, and angiographic data was reviewed and p-values were calculated using Wilcoxon, linear regression, Cochran Mantel-Haenzsel, or Fischer exact tests.
Results: A total of 63 patients achieved SR-sICH and were enrolled in this analysis. A trend of lower mortality rate was noted in those with shorter PD (31(20)) vs. 36(16) minutes,p=0.2). Patients with mRS≤2 had a PD mean time of 36(21) vs. 30(17) minutes,p=0.3. No statistical effect was noted when comparing mortality and mRS within the quartiles of PD time (p=0.39 and p=0.41, respectively). No statistical difference in mRS, good neurological outcome, and mortality when PD dichotomizing to≤1 hour (n=59) vs. >1 hour (n=4). A multivariate model for predicting mRS at 90 days which included PD, age, initial NIHSS, atrial fibrillation, gender, initial systolic and diastolic blood pressure, showed no statistical significance of PD (p=0.8).
Conclusions: Thrombectomy procedure duration, defined as time from groin puncture to revascularization, did not show a relationship with mRS or good neurological outcome in revascularized patients of the SWIFT trial. A trend toward lower mortality was noted in patients who had a shorter PD. Additional larger sample size prospective trials are needed to clarify the role of PD on clinical outcome.
- © 2012 by American Heart Association, Inc.