Alhabli Ibrahim, Benali Faysal, Hill Michael D, Murphy Sean, Toni Danilo, Patrik Michel, Casetta Ilaria, Power Sarah, Saia Valentina, Pracucci Giovanni, Mangiafico Salvatore, Boyle Karl, Nannoni Stefania, Fainardi Enrico, Thornton John, Kim Beom Joon, Menon Bijoy K, Almekhlafi Mohammed A, Bala Fouzi
Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, University of Calgary, Canada.
Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre+ (MUMC+), The Netherlands.
Neuroradiol J. 2025 Jan 13:19714009251313512. doi: 10.1177/19714009251313512.
Successful and complete reperfusion should be the aim of every endovascular thrombectomy (EVT) procedure. However, the effect of time delays on successful reperfusion in late window stroke patients presenting 6-to-24 h from onset has not been investigated.
We pooled individual patient-level data from seven trials and registries for anterior circulation stroke patients treated with EVT between 6 and 24 h from onset. We explored the impact of delays across multiple interval times, including onset to hospital arrival; hospital arrival to arterial puncture; imaging to arterial puncture; and onset to arterial puncture. Our primary outcome was successful reperfusion, defined as a modified thrombolysis in cerebral infarction (mTICI) score of 2b-3. Logistic regression analyses were performed to assess the association between each of the interval times and successful reperfusion.
We included 608 patients. The median age was 70 years (IQR 58-79), and 307 (50.5%) were females. Successful reperfusion was achieved in 494 (81.2%) patients. Patients with successful reperfusion had lower NIHSS scores (median 15 [IQR11-19] vs 17 [11-21], = .02) and significantly shorter hospital arrival to arterial puncture time (90 min [60-150] vs 110 min [84.5-150], = .01) than unsuccessful reperfusion. The odds of successful reperfusion decreased by 15% for every one-hour delay in arrival-to-puncture time (adjusted odds ratio 0.85, 95% CI: 0.75-0.95). Other workflow times did not impact the rate of successful reperfusion.
Faster hospital arrival to arterial puncture time is associated with higher odds of successful reperfusion in late window stroke patients.
成功且完全的再灌注应是每例血管内血栓切除术（EVT）的目标。然而，对于发病6至24小时的晚期窗卒中患者，时间延迟对成功再灌注的影响尚未得到研究。
我们汇总了7项试验和登记处的个体患者水平数据，这些数据来自发病6至24小时接受EVT治疗的前循环卒中患者。我们探讨了多个间隔时间延迟的影响，包括发病至入院；入院至动脉穿刺；影像学检查至动脉穿刺；以及发病至动脉穿刺。我们的主要结局是成功再灌注，定义为脑梗死改良溶栓（mTICI）评分2b - 3。进行逻辑回归分析以评估每个间隔时间与成功再灌注之间的关联。
我们纳入了608例患者。中位年龄为70岁（四分位间距58 - 79），307例（50.5%）为女性。494例（81.2%）患者实现了成功再灌注。成功再灌注的患者美国国立卫生研究院卒中量表（NIHSS）评分较低（中位数15[四分位间距11 - 19] vs 17[11 - 21]，P = 0.02），且入院至动脉穿刺时间明显更短（90分钟[60 - 150] vs 110分钟[84.5 - 150]，P = 0.01），高于未成功再灌注的患者。穿刺时间每延迟1小时，成功再灌注的几率降低15%（调整后的优势比0.85，95%置信区间：0.75 - 0.95）。其他工作流程时间并未影响成功再灌注率。
在晚期窗卒中患者中，更快的入院至动脉穿刺时间与更高的成功再灌注几率相关。
