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  • Each minute in the puncture-to-recanalization interval has more weight on clinical outcome than onset-to-puncture interval

    Final Number:

    Daniel Wei; Thomas Oxley; Dominic Anthony Nistal; Hazem Shoirah; Justin Robert Mascitelli MD; Natalie Wilson; John Liang; Ahmed J Awad MD; Christopher P Kellner MD; Reade De Leacy; Stephan A. Mayer MD; Stanley Tuhrim; Joshua B. Bederson MD; J Mocco MD, MS; Johanna Fifi MD

    Study Design:

    Subject Category:
    Ischemic Stroke

    Meeting: AANS/CNS Cerebrovascular Section 2017 Annual Meeting

    Introduction: Onset-to-recanalization is a commonly used metric associated with clinical outcomes in stroke. A more nuanced understanding of the treatment timeline through investigating relative importance of time intervals within onset-to-recanalization may help better define the therapeutic window for thrombectomy in stroke guidelines.

    Methods: We performed a retrospective analysis on 95 stroke patients who received endovascular treatment for acute stroke at four hospitals in Manhattan. Exclusion criteria include patients who received neurointervention more than 12 hours after last known well. Relative weight of onset-to-puncture and puncture-to-recanalization time intervals were determined using a generalized linear model.

    Results: Mean onset-to-puncture time was 265 minutes and mean puncture-to-recanalization time was 49 minutes with -3.9 change in NIHSS from admission to discharge. Onset-to-puncture and puncture-to-recanalization intervals were both found to be significant predictors of clinical outcomes in a generalized linear model (P=0.0441, P=0.0012). The model coefficients suggest procedure times have greater weight than preprocedure times in a 16:5 ratio with respect to clinical outcomes.

    Conclusions: Every minute spent in an endovascular procedure is equivalent to 3.2 preprocedure minutes in terms of impact on clinical outcome. Procedure times comprised 16% of onset-to-recanalization times but have a disproportionate weight on immediate outcomes. This effect may be because puncture-to-recanalization occurs later in the onset-to-recanalization interval, and may not be related to occurrences specific to puncture-to-recanalization. Considering the relative importance of onset-to-puncture and puncture-to-recanalization may inform stroke protocols and therapeutic windows for intervention.

    Patient Care: This research may inform stroke protocols and windows for treatment through a better understanding of relative importance of time intervals within onset-to-recanalization.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of onset-to-recanalization intervals for neurointervention, 2) Discuss, in small groups, the importance of onset-to-puncture and puncture-to-recanalization on treatment outcomes, 3) Identify an effective treatment window for neurointervention for ischemic stroke.


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