Minor stroke, major stakes: impact of procedure duration on thrombectomy outcomes in minor stroke.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Abo Kasem Rahim, El Baba Bachar, Ma Tianwen, Zelmanovich Rebecca, Pabaney Aqueel, Raheb Khelo Roy, Giraudo Francesca, Chacon Ariana, Chandler Katherine, Elawady Sameh Samir, Chalhoub Reda, Howard Brian M, Levitt Michael R, Grandhi Ramesh, Mascitelli Justin, Cawley Charles Michael, Akbik Feras, Chisango Zvipo, Quintero Wolfe Stacey, Kim Joon-Tae, Jabbour Pascal, Yoshimura Shinichi, Maier Ilko, Ogilvy Christopher S, Ezzeldin Mohamad, Psychogios Marios-Nikos, Siddiqui Fazeel, Navia Pedro, Goyal Nitin, Arthur Adam S, Romano Daniele G, Fragata Isabel, Daglioglu Ergun, Altschul David, Park Min S, Crosa Roberto, Brinjikji Waleed, Moss Mark, Dye Justin, Alaraj Ali, Kan Peter, Limaye Kaustubh, Mokin Maxim, Starke Robert M, Spiotta Alejandro M, Grossberg Jonathan A, Alawieh Ali M
Аннотация
METHODS: The authors analyzed 5693 patients from the STAR (Stroke and Thrombectomy and Aneurysm Registry), including 398 with low NIHSS scores, to evaluate the association between procedure time (PT) and outcomes. Among patients with low NIHSS scores, propensity score matching was used to compare outcomes between those with PT ≤ 35 versus > 35 minutes, a cutoff defined using receiver operating characteristic curve analysis. The authors performed a meta-analysis of studies reporting best medical management (BMM) outcomes in patients with low NIHSS scores. To compare these with EVT-treated patients, a matched BMM comparator cohort using stratification on pooled baseline characteristics was constructed. Outcomes included 90-day functional independence (modified Rankin Scale [mRS] scores 0-2), intracranial hemorrhage, and mortality.
RESULTS: PT had a stronger negative effect on outcomes in patients with low NIHSS scores compared with those with high scores, with a steeper decline in functional independence per minute of PT (slope: -0.45% vs -0.21%; p = 0.03 for interaction). Among patients with low scores, PT ≤ 35 minutes was associated with higher 90-day functional independence compared with the propensity score-matching cohort with PT > 35 minutes (82.6% vs 59.0%, p < 0.001). When benchmarked against BMM (75.2% mRS scores 0-2), patients undergoing EVT within 35 minutes had superior outcomes (85.1%, p = 0.047). In contrast, EVT with PT > 35 minutes resulted in worse outcomes than BMM (mRS scores 0-2: 59.8%, p = 0.008). The number needed to treat for PT ≤ 35 minutes was 10, whereas PT > 35 minutes yielded a number needed to harm of 6.
CONCLUSIONS: PT critically modulates the benefit of EVT in minor stroke. While efficient EVT yields better outcomes than BMM, prolonged procedures are associated with harm. These findings may explain prior inconsistent evidence on EVT in patients with low NIHSS scores and underscore the need to individualize procedural thresholds in this population.