Symptom-reperfusion time significantly impacted 90-day favorable outcomes in fast infarct progressors (aOR 0.541; 95% CI 0.309-0.946; p=0.03) but not in slow progressors.
Cohort (n=137)
Does symptom-reperfusion time impact 90-day functional outcomes differently in slow versus fast infarct progressors undergoing mechanical thrombectomy for MCA-M1 occlusion?
The impact of symptom-to-reperfusion time on 90-day functional outcomes after mechanical thrombectomy is significant in fast infarct progressors but not in slow progressors.
Effect estimate: aOR 7.226 (95% CI 2.431-21.482)
Absolute Event Rate: 71.9% vs 38.9%
p-value: p=< 0.001
BACKGROUND AND PURPOSE: Infarct growth rate (IGR) in acute ischemic stroke is highly variable. We sought to evaluate impact of symptom-reperfusion time on outcomes in patients undergoing mechanical thrombectomy (MT). METHODS: A prospectively maintained database from January,2012-August,2020 was reviewed. All patients with isolated MCA-M1 occlusion who achieved complete reperfusion(mTICI2C-3), had a witnessed symptom onset and follow-up MRI were included. IGR was calculated as final infarct volume (FIV)(ml)/symptom onset to reperfusion time(hours) and was dichotomized according to the median value into slow-(SP) versus fast-progressors (FP). The primary analysis aimed to evaluate the impact of symptom-reperfusion time on 90-day mRS in SP and FP. Secondary analysis was performed to identify predictors of IGR. RESULTS: A total of 137 patients were eligible for analysis. Mean age was 63 ± 15.4 years and median IGR was 5.13ml/hour. SP(n = 69) had higher median ASPECTS, lower median rCBF<30% lesion volume, higher proportion of favorable collaterals and hypoperfusion intensity ratio (HIR)<0.4, higher minimal mean arterial blood pressure before reperfusion, and lower rates of general anesthesia compared to FP(n = 68). Symptom-reperfusion time was comparable between both groups. SP had higher rates of 90-day mRS0-2(71.9%vs.38.9%,aOR;7.226,95%CI2.431-21.482,p < 0.001) and lower median FIV. Symptom-reperfusion time was associated with 90-day mRS0-2 in FP (aOR;0.541,95%CI0.309-0.946,p = 0.03) but not in SP (aOR;0.874,95%CI0.742-1.056,p = 0.16). On multivariable analysis, high ASPECTS and favorable collaterals in the NCCT/CTA model, and low rCBF<30% and HIR<0.4 in the CTP model were independent predictors of SP. CONCLUSIONS: The impact of symptom-reperfusion time on outcomes significantly varies across slow-versus fast-progressors. ASPECTS, collateral score, rCBF<30%, and HIR define stroke progression profile.
Mohammaden et al. (Tue,) conducted a cohort in Acute ischemic stroke with isolated MCA-M1 occlusion (n=137). Symptom-reperfusion time vs. Fast versus slow progressors was evaluated on 90-day mRS 0-2 (aOR 7.226, 95% CI 2.431-21.482, p=< 0.001). Symptom-reperfusion time significantly impacted 90-day favorable outcomes in fast infarct progressors (aOR 0.541; 95% CI 0.309-0.946; p=0.03) but not in slow progressors.