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Shortening time to endovascular treatment improves stroke outcomes
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The association between time to endovascular treatment and functional outcomes in patients with acute ischemic stroke may be stronger than previously reported, according to findings published in Circulation.
According to the results of the MR CLEAN registry, functional outcomes for patients with acute ischemic stroke may be significantly improved by shortening the time between onset and treatment.
“When it comes to acute ischemic stroke treatment, we have learned from randomized trials regarding intravenous alteplase treatment, that time is brain,” Maxim J.H.L. Mulder, MD, PhD, from the Erasmus Medical Center, University Medical Center in Rotterdam, the Netherlands, and colleagues wrote. “Studies performed in clinical practice have extended our knowledge regarding the association of time with outcome and provide data that are better applicable to routine clinical practice.”
To assess the link between time from stroke onset to endovascular therapy and the successful reperfusion with outcomes in current clinical practice, Mulder and colleagues used data from the prospective, observational 1,488-patient MR CLEAN registry, conducted in all 16 centers that perform endovascular therapy in the Netherlands.
A primary analysis assessed the association of time from stroke onset to start of endovascular therapy and time from stroke onset to successful reperfusion with functional outcome by means of ordinal logistic regression.
The researchers found an association between increased time to start of endovascular therapy and worse functional outcome (adjusted common OR = 0.83 per hour; 95% CI, 0.77-0.89) and a mortality rate increase of 2.2% per hour of treatment delay.
The probability of functional independence, defined as a modified Rankin Scale score of 0 to 2, decreased by 5.3% for every 1-hour increase from onset of stroke to start of endovascular therapy.
In the 742 patients with successful reperfusion, every 1-hour increase from stroke onset to reperfusion was associated with a 7.7% decreased probability of functional independence, according to the researchers.
“These findings emphasize that functional outcome of patients who undergo [endovascular therapy] can be greatly improved by shortening onset to treatment times. Reducing delays in the delivery of [endovascular therapy] should be a primary objective of all stroke centers that refer or treat patients with acute ischemic stroke,” the researchers wrote. “Given the clear association of time to treatment with functional outcome, this is an important factor in comparing [endovascular therapy] studies and cohorts.” by Dave Quaile
Disclosures: Mulder reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.
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