Complete reperfusion mitigates influence of treatment time on outcomes after acute stroke

Shyam Prabhakaran, Alicia C. Castonguay, Rishi Gupta, Chung Huan J. Sun, Coleman O. Martin, William Holloway, Nils H. Mueller-Kronast, Joey English, Italo Linfante, Guilherme Dabus, Tim Malisch, Franklin Marden, Hormozd Bozorgchami, Andrew Xavier, Ansaar Rai, Michael Froehler, Aamir Badruddin, Mohammad Asif Taqi, Roberta Novakovic, Michael Abraham & 11 others Vallabh Janardhan, Hashem Shaltoni, Albert J. Yoo, Alex Abou-Chebl, Peng Chen, Gavin Britz, Ritesh Kaushal, Ashish Nanda, Raul Nogueira, Thanh Nguyen, Osama O. Zaidat

Research output: Contribution to journalArticle

10 Citations (Scopus)

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 8 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 3 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 3 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 30 min interval (adj. OR=0.91, 95% CI 0.82 to 0.99). There was an interaction between final TICI grade and 30 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.

Original languageEnglish (US)
Pages (from-to)366-369
Number of pages4
JournalJournal of NeuroInterventional Surgery
Volume9
Issue number4
DOIs
StatePublished - Apr 1 2017

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Brain Ischemia
Reperfusion
Stroke
Therapeutics
National Institutes of Health (U.S.)
Registries
Hemorrhage

Keywords

  • Device
  • Stroke
  • Thrombectomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Prabhakaran, S., Castonguay, A. C., Gupta, R., Sun, C. H. J., Martin, C. O., Holloway, W., ... Zaidat, O. O. (2017). Complete reperfusion mitigates influence of treatment time on outcomes after acute stroke. Journal of NeuroInterventional Surgery, 9(4), 366-369. https://doi.org/10.1136/neurintsurg-2016-012288

Complete reperfusion mitigates influence of treatment time on outcomes after acute stroke. / Prabhakaran, Shyam; Castonguay, Alicia C.; Gupta, Rishi; Sun, Chung Huan J.; Martin, Coleman O.; Holloway, William; Mueller-Kronast, Nils H.; English, Joey; Linfante, Italo; Dabus, Guilherme; Malisch, Tim; Marden, Franklin; Bozorgchami, Hormozd; Xavier, Andrew; Rai, Ansaar; Froehler, Michael; Badruddin, Aamir; Taqi, Mohammad Asif; Novakovic, Roberta; Abraham, Michael; Janardhan, Vallabh; Shaltoni, Hashem; Yoo, Albert J.; Abou-Chebl, Alex; Chen, Peng; Britz, Gavin; Kaushal, Ritesh; Nanda, Ashish; Nogueira, Raul; Nguyen, Thanh; Zaidat, Osama O.

In: Journal of NeuroInterventional Surgery, Vol. 9, No. 4, 01.04.2017, p. 366-369.

Research output: Contribution to journalArticle

Prabhakaran, S, Castonguay, AC, Gupta, R, Sun, CHJ, Martin, CO, Holloway, W, Mueller-Kronast, NH, English, J, Linfante, I, Dabus, G, Malisch, T, Marden, F, Bozorgchami, H, Xavier, A, Rai, A, Froehler, M, Badruddin, A, Taqi, MA, Novakovic, R, Abraham, M, Janardhan, V, Shaltoni, H, Yoo, AJ, Abou-Chebl, A, Chen, P, Britz, G, Kaushal, R, Nanda, A, Nogueira, R, Nguyen, T & Zaidat, OO 2017, 'Complete reperfusion mitigates influence of treatment time on outcomes after acute stroke', Journal of NeuroInterventional Surgery, vol. 9, no. 4, pp. 366-369. https://doi.org/10.1136/neurintsurg-2016-012288
Prabhakaran, Shyam ; Castonguay, Alicia C. ; Gupta, Rishi ; Sun, Chung Huan J. ; Martin, Coleman O. ; Holloway, William ; Mueller-Kronast, Nils H. ; English, Joey ; Linfante, Italo ; Dabus, Guilherme ; Malisch, Tim ; Marden, Franklin ; Bozorgchami, Hormozd ; Xavier, Andrew ; Rai, Ansaar ; Froehler, Michael ; Badruddin, Aamir ; Taqi, Mohammad Asif ; Novakovic, Roberta ; Abraham, Michael ; Janardhan, Vallabh ; Shaltoni, Hashem ; Yoo, Albert J. ; Abou-Chebl, Alex ; Chen, Peng ; Britz, Gavin ; Kaushal, Ritesh ; Nanda, Ashish ; Nogueira, Raul ; Nguyen, Thanh ; Zaidat, Osama O. / Complete reperfusion mitigates influence of treatment time on outcomes after acute stroke. In: Journal of NeuroInterventional Surgery. 2017 ; Vol. 9, No. 4. pp. 366-369.
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title = "Complete reperfusion mitigates influence of treatment time on outcomes after acute stroke",
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 8 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 3 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 3 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 30 min interval (adj. OR=0.91, 95{\%} CI 0.82 to 0.99). There was an interaction between final TICI grade and 30 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.",
keywords = "Device, Stroke, Thrombectomy",
author = "Shyam Prabhakaran and Castonguay, {Alicia C.} and Rishi Gupta and Sun, {Chung Huan J.} and Martin, {Coleman O.} and William Holloway and Mueller-Kronast, {Nils H.} and Joey English and Italo Linfante and Guilherme Dabus and Tim Malisch and Franklin Marden and Hormozd Bozorgchami and Andrew Xavier and Ansaar Rai and Michael Froehler and Aamir Badruddin and Taqi, {Mohammad Asif} and Roberta Novakovic and Michael Abraham and Vallabh Janardhan and Hashem Shaltoni and Yoo, {Albert J.} and Alex Abou-Chebl and Peng Chen and Gavin Britz and Ritesh Kaushal and Ashish Nanda and Raul Nogueira and Thanh Nguyen and Zaidat, {Osama O.}",
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T1 - Complete reperfusion mitigates influence of treatment time on outcomes after acute stroke

AU - Prabhakaran, Shyam

AU - Castonguay, Alicia C.

AU - Gupta, Rishi

AU - Sun, Chung Huan J.

AU - Martin, Coleman O.

AU - Holloway, William

AU - Mueller-Kronast, Nils H.

AU - English, Joey

AU - Linfante, Italo

AU - Dabus, Guilherme

AU - Malisch, Tim

AU - Marden, Franklin

AU - Bozorgchami, Hormozd

AU - Xavier, Andrew

AU - Rai, Ansaar

AU - Froehler, Michael

AU - Badruddin, Aamir

AU - Taqi, Mohammad Asif

AU - Novakovic, Roberta

AU - Abraham, Michael

AU - Janardhan, Vallabh

AU - Shaltoni, Hashem

AU - Yoo, Albert J.

AU - Abou-Chebl, Alex

AU - Chen, Peng

AU - Britz, Gavin

AU - Kaushal, Ritesh

AU - Nanda, Ashish

AU - Nogueira, Raul

AU - Nguyen, Thanh

AU - Zaidat, Osama O.

PY - 2017/4/1

Y1 - 2017/4/1

N2 - 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 8 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 3 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 3 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 30 min interval (adj. OR=0.91, 95% CI 0.82 to 0.99). There was an interaction between final TICI grade and 30 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.

AB - 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 8 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 3 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 3 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 30 min interval (adj. OR=0.91, 95% CI 0.82 to 0.99). There was an interaction between final TICI grade and 30 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.

KW - Device

KW - Stroke

KW - Thrombectomy

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U2 - 10.1136/neurintsurg-2016-012288

DO - 10.1136/neurintsurg-2016-012288

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JO - Journal of NeuroInterventional Surgery

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