Procedure duration predicts outcomes more than prehospital delay in endovascular stroke treatment.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Saad Hassan, Koo Andrew B, Grossberg Jonathan A, Tianwen Ma, Howard Brian M, Sowlat Mohammad-Mahdi, El Baba Bachar, Chacon Ariana, Jabbour Pascal, Rai Ansaar, Dye Justin, Alaraj Ali, Cawley C Michael, Tong Frank C, Akbik Feras, Pabaney Aqueel, Ezzeldin Mohamad, Fiorella David, Yoshimura Shinichi, Kim Joon-Tae, Goyal Nitin, Arthur Adam S, Fragata Isabel, Siddiqui Fazeel M, Mascitelli Justin, Matouk Charles, Maier Ilko, Park Min S, Levitt Michael, Grandhi Ramesh, Psychogios Marios-Nikos, Wolfe Stacey Q, Starke Robert M, Shaban Amir, Samaniego Edgar A, Tanweer Omar, Romano Daniele G, Navia Pedro, Cuellar Hugo H, Polifka Adam J, Osbun Josh, Moss Mark E, Limaye Kaustubh, Mokin Maxim, Brinjikji Waleed, Daglioglu Ergun, Williamson Richard, Altschul David, Ogilvy Christopher S, Crosa Roberto Javier, Gory Benjamin, Paul Alexandra R, Kan Peter, Casagrande Walter, Chowdhry Shakeel A, Stiefel Michael F, Spiotta Alejandro M, Alawieh Ali M, Stroke Thrombectomy and Aneurysm Registry (STAR)
Аннотация
METHODS: A retrospective analysis was conducted of 6644 patients with AIS treated at 44 international stroke centers from the Stroke Thrombectomy and Aneurysm Registry (STAR; 2016-2023). Multivariable regression, time-equivalence analysis, and marginal effects modeling were used to assess associations between PT, OTP, and 90-day modified Rankin Scale (mRS) outcomes. Centers were stratified by procedural efficiency and compared using propensity score matching (PSM). Mediation analysis evaluated whether PT accounted for inter-center differences.
RESULTS: PT and OTP were independently associated with functional outcomes; however, PT had a significantly stronger effect (adjusted OR for mRS 0-2: PT=0.56 vs OTP=0.96 per hour). Each 5 min increase in PT was equivalent to 78-100 min of additional OTP in outcome impact. Centers with faster average PT had higher rates of functional independence (number needed to treat (NNT)=10), fewer complications, and lower symptomatic intracranial hemorrhage rates. PT significantly mediated the relationship between center tier and outcomes (Sobel's P<0.001).
CONCLUSION: While minimizing OTP remains important, PT exerts a greater influence on outcomes after EVT. Procedural efficiency should be emphasized in stroke systems of care and included in center performance metrics to improve patient outcomes.