Deans' stroke musings: Association of time from stroke onset to groin puncture with quality of reperfusion after mechanical thrombectomy: A meta-analysis of individual patient data from 7 randomized clinical trials

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Saturday, January 26, 2019

Association of time from stroke onset to groin puncture with quality of reperfusion after mechanical thrombectomy: A meta-analysis of individual patient data from 7 randomized clinical trials

Dammit, successful reperfusion is not the endpoint to measure. 100% recovery is the measurement. Your stroke patient doesn't give a shit about reperfusion, they want results. 100% RECOVERY. They don't want excuses about why you couldn't accomplish that. We have to change the discussion to 100% recovery. We can't let the stroke world sit on their asses defending the failed status quo.

Association of time from stroke onset to groin puncture with quality of reperfusion after mechanical thrombectomy: A meta-analysis of individual patient data from 7 randomized clinical trials

JAMA Neurology — Bourcier R, et al. | January 24, 2019

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.

Read the full article on JAMA Neurology