Effect of time from onset to endovascular therapy on outcomes: the National Acute Stroke Israeli (NASIS)-REVASC registry.

Abstract

BACKGROUND:

Endovascular therapy (EVT) is currently the most effective treatment for emergent large vessel occlusion (ELVO) stroke. Earlier treatment is associated with a better clinical outcome. Our aim was to examine the association between onset-to-EVT (OTE) time and clinical outcomes using real-world nationwide data from the National Acute Stroke ISraeli (NASIS)-REVASC registry.

METHODS:

Stroke patients undergoing EVT within the Endovascular Capable Centres (ECCs) in Israel between January 2014 and March 2016 were prospectively included. Several clinical and radiological outcomes were evaluated. The association between OTE time and outcomes was analyzed with logistic regression models using time as a continuous variable and then by OTE groups of <2, 2-4, 4-6, and >6 hours.

RESULTS:

299 patients with acute stroke were included in the analysis. OTE time was significantly associated with favorable outcomes. ORs for each hour of delay in EVT were 0.84 (95% CI 0.71 to 0.99) for significant early recovery, 0.80 (95% CI 0.68 to 0.94) for discharge to home, 0.80 (95% CI 0.66 to 0.95) for freedom from disability at discharge, and 0.78 (95% CI 0.67 to 0.91) for excellent reperfusion (Thrombolysis in Cerebral Ischemia 3). The <2 OTE group was significantly associated with better outcomes than the ≥2 OTE group including significant early recovery (OR 3.3, 95% CI 1.2 to 9.1), discharge to home (OR 3.32, 95% CI 1.3 to 8.5), and excellent reperfusion (OR 4.6, 95% CI 1.3 to 29.5). The same trend was observed for freedom from disability at discharge and 3 months (OR 2.08, 95% CI 0.7 to 5.7 and OR 2.57, 95% CI 0.8 to 8.3, respectively). Only 1% of transferred patients achieved an OTE time of <2 hours.

CONCLUSIONS:

Nationwide real-life registry data indicate that benefit from EVT is strongly associated with OTE time and is most prominent within the 'two golden hours' from stroke onset. This time goal may not be applicable in inter-hospital transfer patients.

• Authors: Shlomi Peretz, Guy Raphaeli, Natan Borenstein, Ronen R Leker, Ran Brauner, Anat Horev, José E Cohen, Gregory Telman, Hen Halevi, David Tanne
• Journal: Journal of neurointerventional surgery (J Neurointerv Surg) Vol. 12 Issue 1 Pg. 13-18 (Jan 2020) ISSN: 1759-8486 [Electronic] England
• PMID: 31239333 (Publication Type: Journal Article)
• Copyright: © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

Topics

• Aged
• Aged, 80 and over
• Brain Ischemia (diagnostic imaging, surgery)
• Endovascular Procedures (methods, trends)
• Female
• Humans
• Israel (epidemiology)
• Middle Aged
• Patient Transfer (methods, trends)
• Registries
• Reperfusion (methods, trends)
• Stroke (diagnostic imaging, surgery)
• Time-to-Treatment (trends)
• Treatment Outcome