Medical Student Emory University School of Medicine
Introduction: Longer procedure times have been associated with poor outcomes after endovascular thrombectomy (EVT). Here, we explored the impact of procedure time on outcomes in subgroups of EVT patients.
Methods: This multicenter study included patients undergoing EVT at 35 centers in the US and globally between June 2016 and July 2021. Procedure time was defined as time from groin puncture to successful recanalization (a TICI score of 2B or more) or abortion of procedure. Clinical outcomes were assessed using the 90-day modified Rankin score with scores 0-2 designating good functional outcome. Logistic regression models controlling for co-variates were used to assess the adjusted odds (aOR) of good outcome per 10 min of procedure time. Covariates included: demographics, comorbidities, baseline disability, admission NIHSS.
Results: Among 7441 patients included in the study, longer procedure time was associated with higher odds of poor outcome (mRS 3-6) with 10% increase in odds for each 10 min increment (aOR=1.1,p < 0.01). This effect was more prominent in posterior compared to anterior circulation strokes (aOR 1.17 versus 1.09, p< 0.01), in patients who did not receive IV-tPA (aOR 1.12 vs. 1.08, p< 0.01), and in patients presenting after 16 hours of onset versus those presenting within 6 hours (aOR 1.16 vs. 1.09, p< 0.01). There was an age-dependent increase in impact of longer procedure on poor outcomes (aOR=1.17 in patients > 80 years versus 1.07 in patients between 40-60 years). Despite this difference, the “golden hour” of procedure time still applies to all studied groups. The cumulative rate of good outcome followed an exponential growth curve that plateaus around 60 min of procedure time with a time constant range of 31-37 min.
Conclusion : The negative impact of procedure time on thrombectomy outcomes is more pronounced in older patients, those with posterior circulation strokes, and those presenting at later time from onset.
