Association between procedural time and outcome in unsuccessful mechanical thrombectomy for acute ischemic stroke: analysis from the Italian Registry of Endovascular Treatment in Acute Stroke

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发表日期：

2024年6月5日

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Fabrizio Sallustio,
Ettore Nicolini,
Valentina Saia,
Giovanni Pracucci,
Alfredo Paolo Mascolo,
Federico Marrama,
Roberto Gandini,
Valerio Da Ros,
Marina Diomedi,
Fana Alemseged,
Ilaria Casetta,
Enrico Fainardi,
Lucio Castellan,
Massimo Del Sette,
Nicola Limbucci,
Patrizia Nencini,
Mauro Bergui,
Paolo Cerrato,
Andrea Saletti,
Alessandro De Vito,
Samuele Cioni,
Rossana Tassi,
Luigi Simonetti,
Andrea Zini,
Maria Ruggiero,
Marco Longoni,
Agostino Tessitore,
Ludovica Ferraù,
Nicola Cavasin,
Adriana Critelli,
Stefano Vallone,
Guido Bigliardi,
Domenico Sergio Zimatore,
Marco Petruzzellis,
Andrea Boghi,
Andrea Naldi,
Alessio Comai,
Elisa Dall’Ora,
Giuseppina Sanfilippo,
Alessandra Persico,
Ivan Gallesio,
Federica Sepe,
Roberto Menozzi,
Alessandro Pezzini,
Michele Besana,
Alessia Giossi,
Antioco Sanna,
Tiziana Tassinari,
Nicola Burdi,
Giovanni Boero,
Raffaele Augelli,
Manuel Cappellari,
Mirco Cosottini,
Nicola Giannini,
Daniele G. Romano,
Giulia Frauenfelder,
Paolo Nunzio Nuzzi,
Maria Carmela Spinelli,
Adriana Paladini,
Annalisa Rizzo,
Marco Filizzolo,
Marina Mannino,
Carmine Timpani,
Federica De Santis,
Giuseppe Carità,
Monia Russo,
Gianluca Galvano,
Luigi Sicurella,
Salvatore Mangiafico,
Danilo Toni

摘要

Background

We aim to assess the association between procedural time and outcomes in patients in unsuccessful mechanical thrombectomy (MT) for anterior circulation acute stroke.

Methods

We conducted a cohort study on prospectively collected data from patients with M1 and/or M2 segment of middle cerebral artery occlusion with a thrombolysis in cerebral infarction 0–1 at the end of procedure. Primary outcome was 90-day poor outcome. Secondary outcomes were early neurological deterioration (END), symptomatic intracranial hemorrhage (sICH) according to ECASS II and sICH according to SITS-MOST.

Results

Among 852 patients, after comparing characteristics of favourable and poor outcome groups, logistic regression analysis showed age (OR: 1.04; 95%CI: 1.02–1.05; p < 0.001), previous TIA/stroke (OR: 0.23; 95%CI: 0.12–0.74; p = 0.009), M1 occlusion (OR: 1.69; 95%CI: 1.13–2.50; p = 0.01), baseline NIHSS (OR: 1.01; 95%CI: 1.06–1.13; p < 0.001) and procedural time (OR:1.00; 95% CI: 1.00–1.01; p = 0.003) as independent predictors poor outcome at 90 days. Concerning secondary outcomes, logistic regression analysis showed NIHSS (OR:0.96; 95%CI: 0.93–0.99; p = 0.008), general anaesthesia (OR:2.59; 95%CI: 1.52–4.40; p < 0.001), procedural time (OR: 1.00; 95% CI: 1.00–1.01; p = 0.002) and intraprocedural complications (OR: 1.89; 95%CI: 1.02–3.52; p = 0.04) as independent predictors of END. Bridging therapy (OR:2.93; 95%CI: 1.21–7.09; p = 0.017) was associated with sICH per SITS-MOST criteria whereas M1 occlusion (OR: 0.35; 95%CI: 0.18–0.69; p = 0.002), bridging therapy (OR: 2.02; 95%CI: 1.07–3.82; p = 0.03) and intraprocedural complications (OR: 5.55; 95%CI: 2.72–11.31; p < 0.001) were independently associated with sICH per ECASS II criteria. No significant association was found between the number of MT attempts and analyzed outcomes.

Conclusions

Regardless of the number of MT attempts and intraprocedural complications, procedural time was associated with poor outcome and END. We suggest a deeper consideration of procedural time when treating anterior circulation occlusions refractory to MT.