在早期和晚期治疗时间窗内，治疗时间对血管内血栓切除术结局的影响。
Impact of Time to Treatment on Endovascular Thrombectomy Outcomes in the Early Versus Late Treatment Time Windows.
机构信息
Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL (N.A., K.W., H.G., A.A., C.M.G., H.Y., N.B.S., C.D., G.G.P., S.K., N.K., E.M.-L., D.R.Y., T.R., R.L.S., J.G.R.).
University of South Florida Morsani College of Medicine, Tampa (A.J., D.Z.R.).
出版信息
Stroke. 2023 Mar;54(3):733-742. doi: 10.1161/STROKEAHA.122.040352. Epub 2023 Feb 27.
BACKGROUND
The impact of time to treatment on outcomes of endovascular thrombectomy (EVT) especially in patients presenting after 6 hours from symptom onset is not well characterized. We studied the differences in characteristics and treatment timelines of EVT-treated patients participating in the Florida Stroke Registry and aimed to characterize the extent to which time impacts EVT outcomes in the early and late time windows.
METHODS
Prospectively collected data from Get With the Guidelines-Stroke hospitals participating in the Florida Stroke Registry from January 2010 to April 2020 were reviewed. Participants were EVT patients with onset-to-puncture time (OTP) of ≤24 hours and categorized into early window treated (OTP ≤6 hours) and late window treated (OTP >6 and ≤24 hours). Association between OTP and favorable discharge outcomes (independent ambulation, discharge home and to acute rehabilitation facility) as well as symptomatic intracerebral hemorrhage and in-hospital mortality were examined using multilevel-multivariable analysis with generalized estimating equations.
RESULTS
Among 8002 EVT patients (50.9% women; median age [±SD], 71.5 [±14.5] years; 61.7% White, 17.5% Black, and 21% Hispanic), 34.2% were treated in the late time window. Among all EVT patients, 32.4% were discharged home, 23.5% to rehabilitation facility, 33.7% ambulated independently at discharge, 5.1% had symptomatic intracerebral hemorrhage, and 9.2% died. As compared with the early window, treatment in the late window was associated with lower odds of independent ambulation (odds ratio [OR], 0.78 [0.67-0.90]) and discharge home (OR, 0.71 [0.63-0.80]). For every 60-minute increase in OTP, the odds of independent ambulation reduced by 8% (OR, 0.92 [0.87-0.97]; <0.001) and 1% (OR, 0.99 [0.97-1.02]; =0.5) and the odds of discharged home reduced by 10% (OR, 0.90 [0.87-0.93]; <0.001) and 2% (OR, 0.98 [0.97-1.00]; =0.11) in the early and late windows, respectively.
CONCLUSIONS
In routine practice, just over one-third of EVT-treated patients independently ambulate at discharge and only half are discharged to home/rehabilitation facility. Increased time from symptom onset to treatment is significantly associated with lower chance of independent ambulation and ability to be discharged home after EVT in the early time window.
背景
从症状发作到接受血管内血栓切除术（EVT）治疗的时间对结局的影响，特别是在症状发作后 6 小时以后的患者中，其特征尚未得到很好的描述。我们研究了参与佛罗里达卒中登记处的接受 EVT 治疗的患者的特征和治疗时间线的差异，并旨在描述时间在早期和晚期时间窗内对 EVT 结局的影响程度。
方法
回顾了 2010 年 1 月至 2020 年 4 月期间参与佛罗里达卒中登记处的 Get With the Guidelines-Stroke 医院前瞻性收集的数据。参与者为发病至穿刺时间（OTP）≤24 小时的 EVT 患者，并分为早期窗口治疗（OTP ≤6 小时）和晚期窗口治疗（OTP >6 至 24 小时）。使用广义估计方程的多水平多变量分析来检查 OTP 与良好的出院结局（独立行走、出院回家和到急性康复机构）以及症状性颅内出血和住院死亡率之间的关联。
结果
在 8002 例 EVT 患者中（50.9%为女性；中位年龄[±SD]，71.5[±14.5]岁；61.7%为白人，17.5%为黑人，21%为西班牙裔），34.2%在晚期时间窗内接受治疗。在所有 EVT 患者中，32.4%出院回家，23.5%到康复机构，33.7%出院时独立行走，5.1%发生症状性颅内出血，9.2%死亡。与早期窗口相比，晚期窗口治疗与独立行走的可能性较低（比值比[OR]，0.78[0.67-0.90]）和出院回家的可能性较低（OR，0.71[0.63-0.80]）相关。每增加 60 分钟 OTP，独立行走的可能性就会降低 8%（OR，0.92[0.87-0.97]；<0.001）和 1%（OR，0.99[0.97-1.02]；=0.5），出院回家的可能性分别降低 10%（OR，0.90[0.87-0.93]；<0.001）和 2%（OR，0.98[0.97-1.00]；=0.11），分别在早期和晚期窗口中。
结论
在常规实践中，只有超过三分之一的接受 EVT 治疗的患者能够独立行走，只有一半的患者出院回家/康复机构。从症状发作到治疗的时间延长与 EVT 后早期时间窗内独立行走和出院回家的可能性降低显著相关。
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