Association of Time From Stroke Onset to Groin Puncture With Quality of Reperfusion After Mechanical Thrombectomy
Authors: Romain Bourcier, Mayank Goyal, David S. Liebeskind, Keith W. Muir, Hubert Desal, Adnan H. Siddiqui, Diederik W. J. Dippel, Charles B. Majoie, Wim H. van Zwam, Tudor G. Jovin, Elad I. Levy, Peter J. Mitchell, Olvert A. Berkhemer, Stephen M. Davis, Imad Derraz, Geoffrey A. Donnan, Andrew M. Demchuk, Robert J. van Oostenbrugge, Michael Kelly, Yvo B. Roos, Reza Jahan, Aad van der Lugt, Marieke Sprengers, Stephane Velasco, Geert J. Lycklama à Nijeholt, Wagih Ben Hassen, Paul Burns, Scott Brown, Emmanuel Chabert, Timo Krings, Hana Choe, Christian Weimar, Bruce C. V. Campbell, Gary A. Ford, Marc Ribo, Phil White, Geoffrey C. Cloud, Luis San Roman, Antoni Davalos, Olivier Naggara, Michael D. Hill, Serge Bracard
Journal: JAMA Neurology (2019)

Reperfusion is a key factor for clinical outcome in patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT) for large-vessel intracranial occlusion. However, data are scarce on the association between the time from onset and reperfusion results.To analyze the rate of reperfusion after EVT started at different intervals after symptom onset in patients with AIS.We conducted a meta-analysis of individual patient data from 7 randomized trials of the Highly Effective Reperfusion Using Multiple Endovascular Devices (HERMES) group. This is a multicenter cohort study of the intervention arm of randomized clinical trials included in the HERMES group. Patients with anterior circulation AIS who underwent EVT for M1/M2 or intracranial carotid artery occlusion were included. Each trial enrolled patients according to its specific inclusion and exclusion criteria. Data on patients eligible but not enrolled (eg, refusals or exclusions) were not available. All analyses were performed by the HERMES biostatistical core laboratory using the pooled database. Data were analyzed between December 2010 and April 2015.Successful reperfusion was defined as a modified thrombolysis in cerebral infarction score of 2b/3 at the end of the EVT procedure adjusted for age, occlusion location, pretreatment intravenous thrombolysis, and clot burden score and was analyzed in relation to different intervals (onset, emergency department arrival, imaging, and puncture) using mixed-methods logistic regression.Among the 728 included patients, with a mean (SD) age of 65.4 (13.5) years and of whom 345 were female (47.4%), decreases in rates of successful reperfusion defined as a thrombolysis in cerebral infarction score of 2b/3 were observed with increasing time from admission or first imaging to groin puncture. The magnitude of effect was a 22% relative reduction (odds ratio, 0.78; 95% CI, 0.64-0.95) per additional hour between admission and puncture and a 26% relative reduction (odds ratio, 0.74; 95% CI, 0.59-0.93) per additional hour between imaging and puncture.Because the probability of reperfusion declined significantly with time between hospital arrival and groin puncture, we provide additional arguments for minimizing the intervals after symptom onset in anterior circulation acute ischemic stroke.