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27.05.2022 | Original Article

Time to Endovascular Reperfusion and Outcome in Acute Ischemic Stroke

A Nationwide Prospective Registry in China

verfasst von: Gaoting Ma, Zequan Yu, Baixue Jia, Ying Xian, Zeguang Ren, Dapeng Mo, Ning Ma, Feng Gao, Xu Tong, Xiangqun Shi, Ling Li, Yuesong Pan, Zhongrong Miao, ANGEL-ACT study group

Erschienen in: Clinical Neuroradiology | Ausgabe 4/2022

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Abstract

Purpose

The benefit of endovascular reperfusion therapy for acute ischemic stroke is highly time-dependent but the relation of delays in workflow with outcomes and the key determinants of delays remain uncertain. This study aimed to evaluate the association between faster endovascular therapy and outcomes in a Chinese population with acute ischemic stroke.

Methods

Patients treated with endovascular therapy within 7 h due to anterior large vessel occlusion were enrolled in the ANGEL-ACT registry. Time intervals from hospital arrival to arterial puncture (door-to-puncture), hospital arrival to reperfusion (door-to-reperfusion) and puncture-to-reperfusion were recorded. The outcomes included modified Rankin Scale (mRS) scores 0–1, 0–2, mortality at 3 months, substantial reperfusion, and symptomatic intracranial hemorrhage (sICH).

Results

Of 932 patients receiving endovascular therapy (mean age 65.1 years, 60.1% male), the median door-to-puncture, door-to-reperfusion, and puncture-to-perfusion times were 110min (interquartile range, IQR 72–155min), 200min (IQR, 149–260min), and 76min (IQR, 50–118min). Of the patients 87.4% achieved substantial reperfusion and 9.6% had sICH. The mRS 0–1, 0–2, and mortality at 3 months were 39.8%, 43.2%, and 16.4%. Faster door-to-reperfusion and puncture-to-reperfusion were associated with higher likelihood of mRS 0–1, mRS 0–2, and lower rate of sICH. There was a trend of improved mRS, lower mortality, and fewer ICH with shorter door-to-puncture time; however, most differences were not statistically significant.

Conclusion

Among patients with acute ischemic stroke in routine clinical practice, shorter time to reperfusion was associated with better outcome after endovascular therapy. Standardized workflows and training in endovascular treatment techniques should be promoted nationally to reduce in-hospital delays.

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Titel: Time to Endovascular Reperfusion and Outcome in Acute Ischemic Stroke
A Nationwide Prospective Registry in China
verfasst von: Gaoting Ma
Zequan Yu
Baixue Jia
Ying Xian
Zeguang Ren
Dapeng Mo
Ning Ma
Feng Gao
Xu Tong
Xiangqun Shi
Ling Li
Yuesong Pan
Zhongrong Miao
ANGEL-ACT study group
Publikationsdatum: 27.05.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Neuroradiology / Ausgabe 4/2022
Print ISSN: 1869-1439
Elektronische ISSN: 1869-1447
DOI: https://doi.org/10.1007/s00062-022-01178-7

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Time to Endovascular Reperfusion and Outcome in Acute Ischemic Stroke

A Nationwide Prospective Registry in China