Procedure time and 90-day outcomes after endovascular thrombectomy for large-core stroke.

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.

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.

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.

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.

CONCLUSION

These findings support procedure time as a continuous intraprocedural risk indicator that may inform ongoing procedural reassessment.

CLINICAL TRIAL REGISTRATION: MAGIC registry, ChiCTR.org.cn Identifier: ChiCTR2100051664.