A Critical Assessment of the Golden Hour and the Impact of Procedural Timing in Stroke Thrombectomy
| Autor: | Sudhakar R Satti, Aaron Wessell, Jesse A. Stokum, Timothy R Miller, K. Yarbrough, H Carvalho, Matthew J Kole, Dheeraj Gandhi, Seemant Chaturvedi, Gaurav Jindal, Gregory Cannarsa, Elizabeth Le, Timothy Chryssikos |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Revascularization Logistic regression 030218 nuclear medicine & medical imaging Odds Brain Ischemia Time-to-Treatment 03 medical and health sciences 0302 clinical medicine Internal medicine Diabetes mellitus Medicine Humans Radiology Nuclear Medicine and imaging Stroke Aged Retrospective Studies Thrombectomy Aged 80 and over Interventional business.industry Endovascular Procedures Area under the curve Middle Aged medicine.disease Treatment Outcome Golden hour (medicine) Cardiology Critical assessment Female Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | AJNR Am J Neuroradiol |
| Popis: | BACKGROUND AND PURPOSE: Previous studies in acute ischemic stroke have demonstrated the importance of minimizing delays to endovascular treatment and keeping thrombectomy procedural times at 60 minutes) and time from stroke onset to endovascular therapy (≤6 or >6 hours). Clinical characteristics of patients with postprocedural intracranial hemorrhage were also assessed. Logistic regression was used to determine independent predictors of poor outcome at 90 days (mRS ≥3). RESULTS: Greater age (OR, 1.03; 95% CI, 1.01–1.06; P = .016), higher admission NIHSS score (OR, 1.10; 95% CI, 1.04–1.16; P = .001), history of diabetes mellitus (OR, 1.96; 95% CI, 1.05–3.65; P = .034), and postprocedural intracranial hemorrhage were independently associated with greater odds of poor outcome. Modified TICI scale scores of 2c (OR, 0.11; 95% CI, 0.04–0.28; P 6 hours was independently associated with increased odds of poor outcome (OR, 2.20; 95% CI, 1.11–4.36; P = .024) in the final multivariate model (area under the curve = 0.820). Procedural time was not independently associated with clinical outcome in the final multivariate model (P > .05). CONCLUSIONS: Thrombectomy procedural times beyond 60 minutes are associated with lower revascularization rates and worse 90-day outcomes. Procedural time itself was not an independent predictor of outcome. While stroke thrombectomy procedures should be performed rapidly, our study emphasizes the significance of achieving revascularization despite the requisite procedural time. However, the potential for revascularization must be weighed against the risks associated with multiple thrombectomy attempts. |
| Databáze: | OpenAIRE |
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