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Author Notes:

Address correspondence to: Dr Sunil A. Sheth, Division of Interventional Neuroradiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 2129, Los Angeles, CA 90095-7430. ssheth@post.harvard.edu.

Sunil A. Sheth was responsible for substantial contributions to the conception and design of the work, drafting and critically revising it and its final approval.

Jeffrey L. Saver was responsible for the conception of the work, revising the article, and for its final approval.

Reza Jahan, Jan Gralla, Vitor M. Pereira, Raul G. Nogueira, Elad I. Levy and Osama O. Zaidat were responsible for data acquisition, revising the article and for its final approval.

All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

We thank Drs Jill Schafer and Jeffrey Gornbein for their assistance with the statistical analyses presented in this article.

Potential Conflicts of Interest: Drs. Saver and Jahan have served as an unpaid site investigator in multicenter trials run by Lundbeck and Covidien for which the UC Regents received payments on the basis of clinical trial contracts for the number of subjects enrolled. The University of California has patent rights in retrieval devices for stroke. The University of California receives funding for Dr Saver’s services as a scientific consultant regarding trial design and conduct to Medtronic/Covidien, Stryker, Neuravi, and Boehringer Ingelheim (prevention only). Dr. Saver serves as an unpaid consultant to Genentech advising on the design and conduct of the PRISMS trial; neither the University of California nor Dr. Saver received any payments for this voluntary service. Drs Levy, Gralla, Nogueira, Zaidat, and Pereira have served as site investigators and/or consultants for Coviden. Dr. Levy served as a principal investigator for the Covidien USA SWIFT PRIME Trial.

Subjects:

Keywords:

  • Life Sciences & Biomedicine
  • Clinical Neurology
  • Neurosciences
  • Neurosciences & Neurology
  • ACUTE ISCHEMIC-STROKE
  • TISSUE-PLASMINOGEN ACTIVATOR
  • RANDOMIZED-TRIAL
  • THROMBECTOMY
  • REVASCULARIZATION
  • OUTCOMES
  • TREAT

Time to Endovascular Reperfusion and Degree of Disability in Acute Stroke

Tools:

Journal Title:

Annals of Neurology

Volume:

Volume 78, Number 4

Publisher:

, Pages 584-593

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Objective: Faster time from onset to recanalization (OTR) in acute ischemic stroke using endovascular therapy (ET) has been associated with better outcome. However, previous studies were based on less-effective first-generation devices, and analyzed only dichotomized disability outcomes, which may underestimate the full effect of treatment. Methods: In the combined databases of the SWIFT and STAR trials, we identified patients treated with the Solitaire stent retriever with achievement of substantial reperfusion (Thrombolysis in Cerebral Infarction [TICI] 2b–3). Ordinal numbers needed to treat values were derived by populating joint outcome tables. Results: Among 202 patients treated with ET with TICI 2b to 3 reperfusion, mean age was 68 (±13), 62% were female, and median National Institutes of Health Stroke Scale (NIHSS) score was 17 (interquartile range [IQR]: 14– 20). Day 90 modified Rankin Scale (mRS) outcomes for OTR time intervals ranging from 180 to 480 minutes showed substantial time-related reductions in disability across the entire outcome range. Shorter OTR was associated with improved mean 90-day mRS (1.4 vs. 2.4 vs. 3.3, for OTR groups of 124–240 vs. 241–360 vs. 361–660 minutes; p < 0.001). The number of patients identified as benefitting from therapy with shorter OTR were 3-fold (range, 1.5–4.7) higher on ordinal, compared with dichotomized analysis. For every 15-minute acceleration of OTR, 34 per 1,000 treated patients had improved disability outcome. Interpretation: Analysis of disability over the entire outcome range demonstrates a marked effect of shorter time to reperfusion upon improved clinical outcome, substantially higher than binary metrics. For every 5-minute delay in endovascular reperfusion, 1 of 100 patients has a worse disability outcome.

Copyright information:

© 2015 American Neurological Association.

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