Association between door-to-needle time and outcomes in acute ischemic stroke patients treated with intravenous thrombolysis plus mechanical thrombectomy: Analysis from the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS).
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Sallustio Fabrizio, Mascolo Alfredo Paolo, Marrama Federico, Diomedi Marina, Lacidogna Giordano, D'Agostino Federica, Alemseged Fana, Da Ros Valerio, Sabuzi Federico, Fainardi Enrico, Casetta Ilaria, Vallone Stefano, Bigliardi Guido, Allegretti Luca, Coco Elena, Lafe Elvis, Longoni Marco, Semeraro Vittorio, Boero Giovanni, Petralia Benedetto, Cappellari Manuel, Nicolini Ettore, Ciacciarelli Antonio, Romano Daniele Giuseppe, Napoletano Rosa, Boghi Andrea, Naldi Andrea, Saletti Andrea, De Vito Alessandro, Vinci Sergio Lucio, Ferraù Ludovica, Zimatore Domenico Sergio, Petruzzellis Marco, Bergui Mauro, Bosco Giovanni, Gallesio Ivan, Ferrandi Delfina, Cosottini Mirco, Giannini Nicola, Comai Alessio, Dall'Ora Elisa, Barchetti Giovanni, Caggiula Marcella, Cavasin Nicola, Critelli Adriana, Perri Marco, De Santis Federica, Galluzzo Simone, Zini Andrea, Zilahi De Gyurgyokai Simone, Loizzo Nicola, Menozzi Roberto, Pezzini Alessandro, Sponza Massimo, Merlino Giovanni, Filizzolo Marco, Mannino Marina, Carità Giuseppe, Russo Monia, Allegritti Massimiliano, Caproni Stefano, Besana Michele, Giossi Alessia, Cioni Samuele, Tassi Rossana, Galvano Gianluca, Saracco Eleonora, Limbucci Nicola, Puglielli Edoardo, Casalena Alfonsina, Mangiafico Salvatore, Toni Danilo
Аннотация
MATERIALS AND METHODS: Patients with AIS secondary to middle cerebral artery or intracranial internal carotid artery occlusion with known times of symptoms onset, directly presenting to an MT-capable center, were included in the analysis. According to pre-defined DTN cut-off values (⩽30, ⩽45, and ⩽60 min), we evaluated the association between DTN and outcomes by multivariate logistic regression analyses. Effectiveness outcomes were 3-month functional independence, 3-month excellent outcome and successful reperfusion. Safety outcomes were any intracranial hemorrhage (ICH), symptomatic intracerebral hemorrhage (sICH), and 3-month mortality.
RESULTS: About 1602 patients were included in our analysis. After logistic regression analysis, a DTN ⩽ 60 min was significantly associated with 3-month functional independence (OR 1.36; 95% CI 1.02-1.82). DTNs ⩽ 30, ⩽45, and ⩽60 min were significantly associated with successful reperfusion (OR 2.66; 95% CI 1.6-4.43; OR 1.68; 95%CI 1.25-2.26; OR 1.57; 95% CI 1.21-2.05; respectively). A DTN ⩽ 60 min was also significantly associated with lower rate of any ICH (OR 0.61; 95% CI 0.43-0.86). DTNs ⩽ 30, ⩽45, and ⩽60 min were significantly associated with lower 3-month mortality (OR 0.24; 95% CI 0.08-0.67; OR 0.45; 95% CI 0.29-0.72; OR 0.58; 95% CI 0.39-0.84; respectively).
CONCLUSIONS: In patients with AIS treated with IVT + MT, a shorter DTN is associated with better outcomes if IVT is initiated within 1 h of hospital admission.