Effect of Pre- and In-Hospital Delay on Reperfusion in Acute Ischemic Stroke Mechanical Thrombectomy

YOU BLITHERING IDIOTS STILL DON'T KNOW HOW FAST YOU NEED TO  DO tPA TO GET 100% RECOVERY.  In this research in mice the needed time frame for tPA delivery is 3 minutes.

Electrical 'storms' and 'flash floods' drown the brain after a stroke

 

'Think your stroke team can do that?' Since you will never meet that goal you are going to have to go down the difficult route of solving the 5 causes of the neuronal cascade of death in the first week. 100% recovery is still expected.

 

The latest here:

Effect of Pre- and In-Hospital Delay on Reperfusion in Acute Ischemic Stroke Mechanical Thrombectomy

Johannes Kaesmacher

,

Basel Maamari

,

Thomas R. Meinel

,

Eike I. Piechowiak

,

Pascal J. Mosimann

,

Pasquale Mordasini

,

Martina Goeldlin

,

Marcel Arnold

,

Tomas Dobrocky

, … See all authors

Originally published16 Sep 2020https://doi.org/10.1161/STROKEAHA.120.030208Stroke. 2020;51:2934–2942

Abstract

Background and Purpose:

Post hoc analyses of randomized controlled clinical trials evaluating mechanical thrombectomy have suggested that admission-to-groin-puncture (ATG) delays are associated with reduced reperfusion rates.(Wrong goal; 100% recovery is the goal. Not this crapola of the tyranny of low expectations you want to push.) Purpose of this analysis was to validate this association in a real-world cohort and to find associated factors and confounders for prolonged ATG intervals.

Methods:

Patients included into the BEYOND-SWIFT cohort (Bernese-European Registry for Ischemic Stroke Patients Treated Outside Current Guidelines With Neurothrombectomy Devices Using the Solitaire FR With the Intention for Thrombectomy; https://www.clinicaltrials.gov; Unique identifier: NCT03496064) were analyzed (n=2386). Association between baseline characteristics and ATG was evaluated using mixed linear regression analysis. The effect of increasing symptom-onset-to-admission and ATG intervals on successful reperfusion (defined as Thrombolysis in Cerebral Infarction [TICI] 2b-3) was evaluated using logistic regression analysis adjusting for potential confounders.

Results:

Median ATG was 73 minutes. Prolonged ATG intervals were associated with the use of magnetic resonance imaging (+19.1 [95% CI, +9.1 to +29.1] minutes), general anesthesia (+12.1 [95% CI, +3.7 to +20.4] minutes), and borderline indication criteria, such as lower National Institutes of Health Stroke Scale, late presentations, or not meeting top-tier early time window eligibility criteria (+13.8 [95% CI, +6.1 to +21.6] minutes). There was a 13% relative odds reduction for TICI 2b-3 (adjusted odds ratio [aOR], 0.87 [95% CI, 0.79–0.96]) and TICI 2c/3 (aOR, 0.87 [95% CI, 0.79–0.95]) per hour ATG delay, while the reduction of TICI 2b-3 per hour increase symptom-onset-to-admission was minor (aOR, 0.97 [95% CI, 0.94–0.99]) and inconsistent regarding TICI 2c/3 (aOR, 0.99 [95% CI, 0.97–1.02]). After adjusting for identified factors associated with prolonged ATG intervals, the association of ATG delay and lower rates of TICI 2b-3 remained tangible (aOR, 0.87 [95% CI, 0.76–0.99]).

Conclusions:

There is a great potential to reduce ATG, and potential targets for improvement can be deduced from observational data. The association between in-hospital delay and reduced reperfusion rates is evident in real-world clinical data, underscoring the need to optimize in-hospital workflows. Given the only minor association between symptom-onset-to-admission intervals and reperfusion rates, the causal relationship of this association warrants further research.

Registration:

URL: https://www.clinicaltrials.gov. Unique identifier: NCT03496064.