Mechanical thrombectomy for anterior circulation stroke: 5-year experience in a statewide service with differences in pretreatment time metrics across two hospitals sites

• Published in: Journal of neurointerventional surgery Vol. 9; no. 6; p. 535
• Main Authors: Kabra, Ruchi, Phillips, Timothy J, Saw, Jacqui-Lyn, Phatouros, Constantine C, Singh, Tejinder P, Hankey, Graeme J, Blacker, David, Ghia, Darshan, Prentice, David, McAuliffe, William
• Format: Journal Article
• Language: English
• Published: England 01-06-2017
• Subjects: Aged; Aged, 80 and over; Cohort Studies; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prospective Studies; Reperfusion; Retrospective Studies; Stroke - diagnosis; Stroke - epidemiology; Stroke - surgery; Tertiary Care Centers - trends; Thrombectomy - methods; Thrombectomy - trends; Time-to-Treatment - trends; Treatment Outcome; Stroke; Thrombectomy; Standards
• ISSN: 1759-8486
• DOI: 10.1136/neurintsurg-2016-012304

To audit our institutional mechanical thrombectomy (MT) outcomes for acute anterior circulation stroke and examine the influence of workflow time metrics on patient outcomes.
A database of 100 MT cases was maintained throughout May 2010-February 2015 as part of a statewide service provided across two tertiary hospitals (H1 and H2). Patient demographics, stroke and procedural details, blinded angiographic outcomes, and 90-day modified Rankin Scale (mRS) scores were recorded. The following time points in stroke treatment were recorded: stroke onset, hospital presentation, CT imaging, arteriotomy, and recanalization. Statistical analysis of outcomes, predictors of outcome, and differences between the hospitals was carried out.
Thrombolysis in Cerebral Infarction (TICI) 2b/3 reperfusion was 79%. Forty-nine per cent of patients had good clinical outcomes (mRS 0-2). In a subgroup analysis of 76 patients with premorbid mRS 0-1 and first CT performed ≤4.5 h after stroke onset, 60% had good clinical outcomes. Patient and disease characteristics were matched between the two hospitals. H1 had shorter times between hospital presentation and CT (32 vs 55 min, p=0.01), CT and arteriotomy (33 vs 69 min, p=0.00), and stroke onset and recanalization (198 vs 260 min, p=0.00). These time metrics independently predicted good clinical outcome. Median days spent at home in the first 90 days was greater at H1 (61 vs 8, p=0.04) than at H2. A greater proportion of patients treated at H1 were independent (mRS 0-2) at 90 days (54% vs 42%); however, this was not statistically significant (p=0.22).
Outcomes similar to randomized controlled trials are attainable in 'real-world' settings. Workflow time metrics were independent predictors of clinical outcome, and differed between the two hospitals owing to site-specific organizational differences.