Shorter Door-to-Needle Times Are Associated With Better Outcomes After Intravenous Thrombolytic Therapy and Endovascular Thrombectomy for Acute Ischemic Stroke

 But not fast enough, you're not even measuring 100% recovery!

“What's measured, improves.” So said management legend and author Peter F. Drucker 

 

In this research in mice the needed time frame for tPA delivery is 3 minutes for full recovery. CAN YOU DO THAT? Since no one can do that, what are the followup procedures that will still deliver 100% recovery?

Don't allow your hospital to use the tyranny of low expectations to drive their goals for stroke recovery. The only goal in stroke is 100% recovery. You may need to scream at your stroke medical 'professionals' to get them to understand that. 

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

The latest here:

Shorter Door-to-Needle Times Are Associated With Better Outcomes After Intravenous Thrombolytic Therapy and Endovascular Thrombectomy for Acute Ischemic Stroke

Shumei Man,

Nicole Solomon,

Brian Mac Grory,

Brooke Alhanti,

Ken Uchino,

Jeffrey L. Saver,

Eric E. Smith,

Ying Xian,

Deepak L. Bhatt,

Lee H. Schwamm,

Muhammad Shazam Hussain and

Gregg C. Fonarow

Originally published18 May 2023https://doi.org/10.1161/CIRCULATIONAHA.123.064053Circulation. 2023;0

Abstract

BACKGROUND:

Existing data and clinical trials could not determine whether faster intravenous thrombolytic therapy (IVT) translates into better long-term functional outcomes after acute ischemic stroke among those treated with endovascular thrombectomy (EVT). Patient-level national data can provide the required large population to study the associations between earlier IVT, versus later, with longitudinal functional outcomes and mortality in patients receiving IVT+EVT combined treatment.

METHODS:

This cohort study included older US patients (age ≥65 years) who received IVT within 4.5 hours or EVT within 7 hours after acute ischemic stroke using the linked 2015 to 2018 Get With The Guidelines–Stroke and Medicare database (38 913 treated with IVT only and 3946 with IVT+EVT). Primary outcome was home time, a patient-prioritized functional outcome. Secondary outcomes included all-cause mortality in 1 year. Multivariate logistic regression and Cox proportional hazards models were used to evaluate the associations between door-to-needle (DTN) times and outcomes.

RESULTS:

Among patients treated with IVT+EVT, after adjusting for patient and hospital factors, including onset-to-EVT times, each 15-minute increase in DTN times for IVT was associated with significantly higher odds of zero home time in a year (never discharged to home) (adjusted odds ratio, 1.12 [95% CI, 1.06–1.19]), less home time among those discharged to home (adjusted odds ratio, 0.93 per 1% of 365 days [95% CI, 0.89–0.98]), and higher all-cause mortality (adjusted hazard ratio, 1.07 [95% CI, 1.02–1.11]). These associations were also statistically significant among patients treated with IVT but at a modest degree (adjusted odds ratio, 1.04 for zero home time, 0.96 per 1% home time for those discharged to home, and adjusted hazard ratio 1.03 for mortality). In the secondary analysis where the IVT+EVT group was compared with 3704 patients treated with EVT only, shorter DTN times (≤60, 45, and 30 minutes) achieved incrementally more home time in a year, and more modified Rankin Scale 0 to 2 at discharge (22.3%, 23.4%, and 25.0%, respectively) versus EVT only (16.4%, P<0.001 for each). The benefit dissipated with DTN>60 minutes.

CONCLUSIONS:

Among older patients with stroke treated with either IVT only or IVT+EVT, shorter DTN times are associated with better long-term functional outcomes and lower mortality. These findings support further efforts to accelerate thrombolytic administration in all eligible patients, including EVT candidates.

Footnotes

This manuscript was sent to Vincent S Thijs, Guest Editor, for review by expert referees, editorial decision, and final disposition.

Supplemental Material is available at: https://www.ahajournals.org/doi/suppl/10.1161/CIRCULATIONAHA.123.064053