Bourcier R, et al. - In patients with acute ischemic stroke (AIS), researchers evaluated the rate of reperfusion following endovascular thrombectomy (EVT) started at various intervals following symptom onset. The rate of successful reperfusion, defined as a thrombolysis in cerebral infarction score of 2b-3 at the end of the procedure, decreased as time passed following arrival at the stroke endovascular center.

Methods

• Investigators performed a meta-analysis of individual patient data from seven randomized trials of the Highly Effective Reperfusion Using Multiple Endovascular Devices (HERMES) group.
• For this investigation, they involved patients with anterior circulation AIS who had EVT for M1/M2 or intracranial carotid artery occlusion.
• Each trial enrolled patients based on their specific criteria for inclusion and exclusion.
• Data were not available on patients who were eligible but not registered (eg, refusals or exclusions).
• Using the pooled database, all analyses were performed by the HERMES biostatistical core laboratory.
• Between December 2010 and April 2015, data were analyzed.
• Using mixed-methods logistic regression, 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).

Results

• Of the 728 patients with a mean (SD) age of 65.4 (13.5) years, 345 of whom were female (47.4%), decreases in successful reperfusion rates, defined as thrombolysis in cerebral infarction score of 2b/3, were seen with increasing time from admission or first imaging to groin puncture.
• Data reported that 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.