Complete reperfusion mitigates influence of treatment time on outcomes after acute stroke.
J Neurointerv Surg
; 9(4): 366-369, 2017 Apr.
Article
en En
| MEDLINE
| ID: mdl-27073195
ABSTRACT
BACKGROUND:
Time to reperfusion following endovascular treatment (ET) predicts outcomes after acute ischemic stroke (AIS).OBJECTIVE:
To assess the time-outcome relationship within reperfusion grades in the North American Solitaire Acute Stroke registry.METHODS:
We identified patients given ET for anterior circulation ischemic stroke within 8â h from onset and in whom reperfusion was achieved. Together with clinical and outcome data, site-adjudicated modified Thrombolysis in Cerebral Ischemia (TICI) was recorded. We assessed the impact of time to reperfusion (onset to procedure completion time) on good outcome (modified Rankin Scale 0-2 at 3â months) in patients who achieved TICI 2 or higher reperfusion in multivariable models. We further assessed this relationship within strata of reperfusion grades. A p<0.05 was considered significant.RESULTS:
Independent predictors of good outcome at 3â months among those achieving TICI ≥2a reperfusion (n=188) were initial National Institutes of Health Stroke Scale score (adjusted OR=0.90, 95% CI 0.85 to 0.95), symptomatic hemorrhage (adj. OR=0.16, 95% CI 0.05 to 0.60), TICI grade (TICI 3 adj. OR=11.52, 95% CI 3.34 to 39.77; TICI 2b adj. OR=5.14, 95% CI 1.61 to 16.39), and time to reperfusion per 30â min interval (adj. OR=0.91, 95% CI 0.82 to 0.99). There was an interaction between final TICI grade and 30â min time to reperfusion intervals (p=0.001) such that the effect of time was strongest in TICI 2a patients.CONCLUSIONS:
Time to reperfusion was a strong predictor of outcome following ET for AIS. However, the effect varied by TICI grade such that its greatest effect was in those achieving TICI 2a reperfusion.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
2_ODS3
Problema de salud:
2_muertes_prematuras_enfermedades_notrasmisibles
Asunto principal:
Reperfusión
/
Infarto Cerebral
/
Isquemia Encefálica
/
Trombectomía
/
Accidente Cerebrovascular
/
Intervención Médica Temprana
Tipo de estudio:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
J Neurointerv Surg
Año:
2017
Tipo del documento:
Article
País de afiliación:
Estados Unidos