Abstract W MP1: Collateral Grade Drives the Importance of Time to Reperfusion in the Stentriever Era: The ENDOSTROKE Registry
Background: Time to angiographic reperfusion has been hailed as paramount to all other factors in achieving good clinical outcomes after endovascular stroke therapy (EVT). Heterogeneity in collateral status, however, may dictate the individual timecourse of therapeutic risk/benefit in a given patient. Time to earliest reperfusion (Thrombolysis in Cerebral Ischemia 2A or TICI2A) has not been previously analyzed and this measure may considerably decrease with recent use of modern stentriever devices.
Methods: ENDOSTROKE is an industry-independent, centrally-monitored multicenter registry evaluating EVT in routine clinical practice. Central reading of angiographic data blinded to clinical information was performed by the core lab. For these analyses, we selected only proximal MCA occlusions proven as TICI 0 before EVT, with available ASITN collateral grade and final TICI 2B-3. The data center analyzed the relationship of these angiographic parameters with clinical variables, including 90-day mRS 0-2 (good clinical outcome).
Results: 116 patients met these strict inclusion criteria. Median age was 72 years (63, 76) with median initial NIHSS 15 (12, 19). 80 had good collaterals (ASTIN grades 3-4), 36 patients had poor collaterals (ASITN grades 0-2). Both groups did not differ significantly concerning age or initial NIHSS. Good clinical outcome was reached by 51% with good and 42% with poor collaterals (p=0.339). Time from symptom onset to the start of angiography was similar in both groups (200 min vs. 186 min in good vs. poor collaterals, p=0.393). However, in the poor collaterals group, time to TICI 2A was significantly shorter in patients with good clinical outcome (177 min (151, 221)) than in patients with poor clinical outcome (261 min (184, 326), p=0.012). In patients with good collaterals, no significant difference of the time to TICI 2A was found between good (229 min (152, 281)) and poor outcome (230 min (178, 298), p=0.779).
Conclusions: Time to angiographic reperfusion, from symptom onset to earliest reperfusion (TICI 2A) dominates endovascular procedure time. Time is paramount in those with poor collaterals, whereas time may be irrelevant in those with good collaterals.
Author Disclosures: D.S. Liebeskind: Consultant/Advisory Board; Modest; Stryker, Covidien. Research Grant; Significant; NIH-NINDS. J. Berkefeld: None. K. Niederkorn: None. H. Deutschmann: None. A. Reich: None. M. Wiesmann: Consultant/Advisory Board; Modest; Stryker. K. Gröschel: None. S. Boor: None. C.H. Nolte: None. G. Bohner: Honoraria; Modest; Penumbra. T. Neumann-Haefelin: None. E. Hofmann: None. A. Stoll: None. A. Bormann: None. F. Scalzo: None. C. Weimar: Speakers' Bureau; Modest; Boehringer Ingelheim, Penumbra. M.U. Schlamann: None. O.C. Singer: None.
- © 2015 by American Heart Association, Inc.