TY - JOUR
T1 - Effect of time from onset to endovascular therapy on outcomes
T2 - The National Acute Stroke Israeli (NASIS)-REVASC registry
AU - Peretz, Shlomi
AU - Raphaeli, Guy
AU - Borenstein, Natan
AU - Leker, Ronen R.
AU - Brauner, Ran
AU - Horev, Anat
AU - Cohen, José E.
AU - Telman, Gregory
AU - Halevi, Hen
AU - Tanne, David
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2020.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Background Endovascular therapy (EVT) is currently the most effective treatment for emergent large vessel occlusion (ELVO) stroke. Earlier treatment is associated with a better clinical outcome. Our aim was to examine the association between onset-to-EVT (OTE) time and clinical outcomes using real-world nationwide data from the National Acute Stroke ISraeli (NASIS)-REVASC registry. Methods Stroke patients undergoing EVT within the Endovascular Capable Centres (ECCs) in Israel between January 2014 and March 2016 were prospectively included. Several clinical and radiological outcomes were evaluated. The association between OTE time and outcomes was analyzed with logistic regression models using time as a continuous variable and then by OTE groups of <2, 2-4, 4-6, and >6 hours. Results 299 patients with acute stroke were included in the analysis. OTE time was significantly associated with favorable outcomes. ORs for each hour of delay in EVT were 0.84 (95% CI 0.71 to 0.99) for significant early recovery, 0.80 (95% CI 0.68 to 0.94) for discharge to home, 0.80 (95% CI 0.66 to 0.95) for freedom from disability at discharge, and 0.78 (95% CI 0.67 to 0.91) for excellent reperfusion (Thrombolysis in Cerebral Ischemia 3). The <2 OTE group was significantly associated with better outcomes than the ≥2 OTE group including significant early recovery (OR 3.3, 95% CI 1.2 to 9.1), discharge to home (OR 3.32, 95% CI 1.3 to 8.5), and excellent reperfusion (OR 4.6, 95% CI 1.3 to 29.5). The same trend was observed for freedom from disability at discharge and 3 months (OR 2.08, 95% CI 0.7 to 5.7 and OR 2.57, 95% CI 0.8 to 8.3, respectively). Only 1% of transferred patients achieved an OTE time of <2 hours. Conclusions Nationwide real-life registry data indicate that benefit from EVT is strongly associated with OTE time and is most prominent within the two golden hours' from stroke onset. This time goal may not be applicable in inter-hospital transfer patients.
AB - Background Endovascular therapy (EVT) is currently the most effective treatment for emergent large vessel occlusion (ELVO) stroke. Earlier treatment is associated with a better clinical outcome. Our aim was to examine the association between onset-to-EVT (OTE) time and clinical outcomes using real-world nationwide data from the National Acute Stroke ISraeli (NASIS)-REVASC registry. Methods Stroke patients undergoing EVT within the Endovascular Capable Centres (ECCs) in Israel between January 2014 and March 2016 were prospectively included. Several clinical and radiological outcomes were evaluated. The association between OTE time and outcomes was analyzed with logistic regression models using time as a continuous variable and then by OTE groups of <2, 2-4, 4-6, and >6 hours. Results 299 patients with acute stroke were included in the analysis. OTE time was significantly associated with favorable outcomes. ORs for each hour of delay in EVT were 0.84 (95% CI 0.71 to 0.99) for significant early recovery, 0.80 (95% CI 0.68 to 0.94) for discharge to home, 0.80 (95% CI 0.66 to 0.95) for freedom from disability at discharge, and 0.78 (95% CI 0.67 to 0.91) for excellent reperfusion (Thrombolysis in Cerebral Ischemia 3). The <2 OTE group was significantly associated with better outcomes than the ≥2 OTE group including significant early recovery (OR 3.3, 95% CI 1.2 to 9.1), discharge to home (OR 3.32, 95% CI 1.3 to 8.5), and excellent reperfusion (OR 4.6, 95% CI 1.3 to 29.5). The same trend was observed for freedom from disability at discharge and 3 months (OR 2.08, 95% CI 0.7 to 5.7 and OR 2.57, 95% CI 0.8 to 8.3, respectively). Only 1% of transferred patients achieved an OTE time of <2 hours. Conclusions Nationwide real-life registry data indicate that benefit from EVT is strongly associated with OTE time and is most prominent within the two golden hours' from stroke onset. This time goal may not be applicable in inter-hospital transfer patients.
KW - endovascular therapy
KW - interhospital transfer
KW - national stroke registry
KW - onset-to-puncture time
KW - real-world data
UR - http://www.scopus.com/inward/record.url?scp=85068177912&partnerID=8YFLogxK
U2 - 10.1136/neurintsurg-2019-014928
DO - 10.1136/neurintsurg-2019-014928
M3 - Article
C2 - 31239333
AN - SCOPUS:85068177912
SN - 1759-8478
VL - 12
SP - 13
EP - 18
JO - Journal of NeuroInterventional Surgery
JF - Journal of NeuroInterventional Surgery
IS - 1
ER -