Association between procedural time and outcome in unsuccessful mechanical thrombectomy for acute ischemic stroke: analysis from the Italian Registry of Endovascular Treatment in Acute Stroke.
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Sallustio Fabrizio, Nicolini Ettore, Saia Valentina, Pracucci Giovanni, Mascolo Alfredo Paolo, Marrama Federico, Gandini Roberto, Da Ros Valerio, Diomedi Marina, Alemseged Fana, Casetta Ilaria, Fainardi Enrico, Castellan Lucio, Del Sette Massimo, Limbucci Nicola, Nencini Patrizia, Bergui Mauro, Cerrato Paolo, Saletti Andrea, De Vito Alessandro, Cioni Samuele, Tassi Rossana, Simonetti Luigi, Zini Andrea, Ruggiero Maria, Longoni Marco, Tessitore Agostino, Ferraù Ludovica, Cavasin Nicola, Critelli Adriana, Vallone Stefano, Bigliardi Guido, Zimatore Domenico Sergio, Petruzzellis Marco, Boghi Andrea, Naldi Andrea, Comai Alessio, Dall'Ora Elisa, Sanfilippo Giuseppina, Persico Alessandra, Gallesio Ivan, Sepe Federica, Menozzi Roberto, Pezzini Alessandro, Besana Michele, Giossi Alessia, Sanna Antioco, Tassinari Tiziana, Burdi Nicola, Boero Giovanni, Augelli Raffaele, Cappellari Manuel, Cosottini Mirco, Giannini Nicola, Romano Daniele G, Frauenfelder Giulia, Nuzzi Paolo Nunzio, Spinelli Maria Carmela, Paladini Adriana, Rizzo Annalisa, Filizzolo Marco, Mannino Marina, Timpani Carmine, De Santis Federica, Carità Giuseppe, Russo Monia, Galvano Gianluca, Sicurella Luigi, Mangiafico Salvatore, Toni Danilo, Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) Collaborators
Аннотация
METHODS: We conducted a cohort study on prospectively collected data from patients with M1 and/or M2 segment of middle cerebral artery occlusion with a thrombolysis in cerebral infarction 0-1 at the end of procedure. Primary outcome was 90-day poor outcome. Secondary outcomes were early neurological deterioration (END), symptomatic intracranial hemorrhage (sICH) according to ECASS II and sICH according to SITS-MOST.
RESULTS: Among 852 patients, after comparing characteristics of favourable and poor outcome groups, logistic regression analysis showed age (OR: 1.04; 95%CI: 1.02-1.05; p < 0.001), previous TIA/stroke (OR: 0.23; 95%CI: 0.12-0.74; p = 0.009), M1 occlusion (OR: 1.69; 95%CI: 1.13-2.50; p = 0.01), baseline NIHSS (OR: 1.01; 95%CI: 1.06-1.13; p < 0.001) and procedural time (OR:1.00; 95% CI: 1.00-1.01; p = 0.003) as independent predictors poor outcome at 90 days. Concerning secondary outcomes, logistic regression analysis showed NIHSS (OR:0.96; 95%CI: 0.93-0.99; p = 0.008), general anaesthesia (OR:2.59; 95%CI: 1.52-4.40; p < 0.001), procedural time (OR: 1.00; 95% CI: 1.00-1.01; p = 0.002) and intraprocedural complications (OR: 1.89; 95%CI: 1.02-3.52; p = 0.04) as independent predictors of END. Bridging therapy (OR:2.93; 95%CI: 1.21-7.09; p = 0.017) was associated with sICH per SITS-MOST criteria whereas M1 occlusion (OR: 0.35; 95%CI: 0.18-0.69; p = 0.002), bridging therapy (OR: 2.02; 95%CI: 1.07-3.82; p = 0.03) and intraprocedural complications (OR: 5.55; 95%CI: 2.72-11.31; p < 0.001) were independently associated with sICH per ECASS II criteria. No significant association was found between the number of MT attempts and analyzed outcomes.
CONCLUSIONS: Regardless of the number of MT attempts and intraprocedural complications, procedural time was associated with poor outcome and END. We suggest a deeper consideration of procedural time when treating anterior circulation occlusions refractory to MT.