Procedure time and 90-day outcomes after endovascular thrombectomy for large-core stroke
Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine
Abstract Introduction Procedure time during endovascular thrombectomy (EVT) has been associated with outcomes in general thrombectomy cohorts, but whether this relationship reflects a threshold or continuous risk accumulation in large-core stroke remains unclear. sec3a Patients and methods We performed a retrospective observational analysis of 490 patients with anterior-circulation large-vessel occlusion (LVO) and large-core infarction, defined by an Alberta Stroke Program Early Computed Tomography Score of 5 or less, from a prospective multicentre registry across 38 centres. Procedure time was analysed categorically and continuously. The primary outcome was the 90-day mRS score of 0–3. Secondary outcomes were 90-day mortality and sICH. Restricted cubic splines tested nonlinearity. sec4a Results Each 10-min increase in procedure time was associated with lower odds of an modified Rankin Scale (mRS) score of 0–3 (odds ratio, 0.91; 95% CI, 0.86–0.95) and higher mortality (odds ratio, 1.07; 95% CI, 1.02–1.11). On the absolute scale, the marginally standardised probability of mRS 0–3 decreased from 44.5% at 60 min to 27.5% at 150 min (absolute risk difference − 17.1 percentage points; 95% CI, − 27.7 to −6.4). Spline analyses showed no evidence of nonlinearity for functional outcome or mortality. No consistent association with sICH was observed across analyses. sec5a Discussion Longer procedure time was associated with progressively worse functional outcome and higher mortality in
Abstract
Abstract Introduction Procedure time during endovascular thrombectomy (EVT) has been associated with outcomes in general thrombectomy cohorts, but whether this relationship reflects a threshold or continuous risk accumulation in large-core stroke remains unclear. sec3a Patients and methods We performed a retrospective observational analysis of 490 patients with anterior-circulation large-vessel occlusion (LVO) and large-core infarction, defined by an Alberta Stroke Program Early Computed Tomography Score of 5 or less, from a prospective multicentre registry across 38 centres. Procedure time was analysed categorically and continuously. The primary outcome was the 90-day mRS score of 0–3. Secondary outcomes were 90-day mortality and sICH. Restricted cubic splines tested nonlinearity. sec4a Results Each 10-min increase in procedure time was associated with lower odds of an modified Rankin Scale (mRS) score of 0–3 (odds ratio, 0.91; 95% CI, 0.86–0.95) and higher mortality (odds ratio, 1.07; 95% CI, 1.02–1.11). On the absolute scale, the marginally standardised probability of mRS 0–3 decreased from 44.5% at 60 min to 27.5% at 150 min (absolute risk difference − 17.1 percentage points; 95% CI, − 27.7 to −6.4). Spline analyses showed no evidence of nonlinearity for functional outcome or mortality. No consistent association with sICH was observed across analyses. sec5a Discussion Longer procedure time was associated with progressively worse functional outcome and higher mortality in large-core EVT, without evidence of a clear nonlinear inflection point. sec5c Conclusion These findings support procedure time as a continuous intraprocedural risk indicator that may inform ongoing procedural reassessment. sec6a Clinical trial registration MAGIC registry,Identifier: ChiCTR2100051664. sec3 Graphical Abstract Graphical abstract summarizing the association between procedure time and 90-day outcomes after endovascular thrombectomy for large-core stroke. In a prospective multicenter registry of 490 patients from 38 centers in China, longer procedure time was associated with a lower probability of favorable functional outcome and higher mortality, without a consistent association with symptomatic intracranial hemorrhage. The findings suggest that procedural risk accumulates continuously rather than increasing only beyond a single time cutoff. http://www.w3.org/1999/xlink float portrait aakag062ga1.jpg float ga1 portrait graphical