Lee Eung-Joon, Jeong Han-Yeong, Kim Jayoun, Park Nan Hee, Kang Min Kyoung, Lee Dongwhane, Kim Jinkwon, Jung Yo Han, Yu Sungwook, Kim Wook-Joo, Cho Han-Jin, Lee Kyungbok, Park Tai Hwan, Oh Mi Sun, Lee Ji Sung, Kim Joon-Tae, Yoon Byung-Woo, Park Jong-Moo, Bae Hee-Joon, Jung Keun-Hwa
Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Institute of Public Health and Care, Seoul National University Hospital, Seoul, Korea.
Neurointervention. 2025 Jul;20(2):71-81. doi: 10.5469/neuroint.2025.00178. Epub 2025 Apr 30.
Procedure time (PT), defined as the time between groin access and vessel recanalization, is a recently recognized predictor of outcomes after endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). However, the factors affecting PT and its potential value as a performance measure of AIS treatment remain unexplored.
Using the Korean Stroke Registry, we compared patients who underwent EVT for AIS from 2018 to 2022 based on 60 minutes PT. We conducted multivariate analysis to investigate whether PT <60 minutes was associated with successful recanalization and good functional stroke outcomes. We also investigated factors that independently predicted PT ≥60 minutes. Furthermore, we determined the cutoff point for PT.
We analyzed 4,703 patients (mean age: 69.5±11.9, 60.3% male) who underwent EVT. The mean PT was 54.6±36.7 minutes. Multivariate analysis revealed that PT <60 minutes independently predicted a good functional outcome as represented by modified Rankin Scale scores of 0-2 (adjusted odds ratio [aOR]: 1.40, 95% confidence interval [CI]: 1.22-1.59). PT <60 minutes was significantly associated with successful recanalization after adjusting for confounding variables (aOR: 1.66, 95% CI: 1.33-2.07). Moreover, after adjusting for covariates, age≥65 years (aOR: 1.20, 95% CI: 1.05-1.38), onset-to-door time (aOR: 1.03, 95% CI: 1.01-1.04), door-to-puncture time (aOR: 1.05, 95% CI: 1.03-1.06), posterior circulation stroke (PCS) (aOR: 1.13, 95% CI: 1.02-1.28), and smoking (aOR: 1.24, 95%CI: 1.09-1.45) independently predicted PT ≥60 minutes. Finally, the highest aOR for good stroke outcome was observed in the 60-minute cutoff model (aOR: 1.45, 95%CI: 1.27-1.67).
PT <60 minutes was significantly associated with good functional outcomes. Conversely, PT ≥60 minutes was associated with older age, PCS, smoking, prolonged onset-to-door and door-to-puncture time. Further studies are necessary to develop refining strategies for optimizing PT to improve stroke outcomes.
手术时间（PT）定义为腹股沟入路至血管再通的时间，是急性缺血性卒中（AIS）血管内血栓切除术（EVT）后近期被认可的预后预测指标。然而，影响PT的因素及其作为AIS治疗性能指标的潜在价值仍未得到探索。
利用韩国卒中登记系统，我们根据60分钟的PT对2018年至2022年接受AIS-EVT治疗的患者进行了比较。我们进行了多变量分析，以研究PT<60分钟是否与成功再通及良好的功能性卒中预后相关。我们还研究了独立预测PT≥60分钟的因素。此外，我们确定了PT的临界值。
我们分析了4703例接受EVT治疗的患者（平均年龄：69.5±11.9岁，男性占60.3%）。平均PT为54.6±36.7分钟。多变量分析显示，PT<60分钟可独立预测改良Rankin量表评分为0-2分所代表的良好功能预后（调整优势比[aOR]：1.40，95%置信区间[CI]：1.22-1.59）。在调整混杂变量后，PT<60分钟与成功再通显著相关（aOR：1.66，95%CI：1.33-2.07）。此外，在调整协变量后，年龄≥65岁（aOR：1.20，95%CI：1.05-1.38）、发病至入院时间（aOR：1.03，95%CI：1.01-1.04）、入院至穿刺时间（aOR：1.05，95%CI：1.03-1.06）、后循环卒中（PCS）（aOR：1.13，95%CI：1.02-1.28）和吸烟（aOR：1.24，95%CI：1.09-1.45）可独立预测PT≥60分钟。最后，在60分钟临界值模型中观察到良好卒中预后的最高aOR（aOR：1.45，95%CI：1.27-1.67）。
PT<60分钟与良好的功能预后显著相关。相反，PT≥60分钟与年龄较大、PCS、吸烟、发病至入院时间和入院至穿刺时间延长有关。有必要进一步研究制定优化PT的策略以改善卒中预后。
