Developing practice recommendations for endovascular revascularization for acute ischemic stroke

Lazzaro, Marc A.; Novakovic, Roberta; Alexandrov, Andrei V.; Darkhabani, Ziad; Edgell, Randall C.; English, Joey; Frei, Donald; Jamieson, Dara G.; Janardhan, Vallabh; Janjua, Nazli; Janjua, Rashid M.; Katzan, Irene; Khatri, Pooja; Kirmani, Jawad F.; Liebeskind, David S; Linfante, Italo; Nguyen, Thanh N.; Saver, Jeffrey L.; Shutter, Lori; Xavier, Andrew; Yavagal, Dileep R.; Zaidat, Osama O.

doi:10.1212/wnl.0b013e31826959fc

Cited by 26 publications

(11 citation statements)

References 62 publications

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“…Based on a widely accepted metric used in cardiology (door to balloon time <90 minutes), the Society for Vascular and Interventional Neurology proposed a door to groin puncture time <90 minutes. 26 Other metrics proposed include baseline imaging to groin puncture (picture to puncture) time <90 minutes and a door to treatment time <120 minutes. 22,27 Our results show that baseline imaging to groin puncture time <90 minutes and a door to treatment time <120 minutes can be achieved (Figure 3).…”

Section: Discussionmentioning

confidence: 99%

Optimal Workflow and Process-Based Performance Measures for Endovascular Therapy in Acute Ischemic Stroke

Menon

Almekhlafi

Pereira

et al. 2014

Stroke

143

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Background and Purpose-We report on workflow and process-based performance measures and their effect on clinical outcome in Solitaire FR Thrombectomy for Acute Revascularization (STAR), a multicenter, prospective, single-arm study of Solitaire FR thrombectomy in large vessel anterior circulation stroke patients. Methods-Two hundred two patients were enrolled across 14 centers in Europe, Canada, and Australia. The following time intervals were measured: stroke onset to hospital arrival, hospital arrival to baseline imaging, baseline imaging to groin puncture, groin puncture to first stent deployment, and first stent deployment to reperfusion. Effects of time of day, general anesthesia use, and multimodal imaging on workflow were evaluated. Patient characteristics and workflow processes associated with prolonged interval times and good clinical outcome (90-day modified Rankin score, 0-2) were analyzed. Results-Median times were onset of stroke to hospital arrival, 123 minutes (interquartile range, 163 minutes); hospital arrival to thrombolysis in cerebral infarction (TICI) 2b/3 or final digital subtraction angiography, 133 minutes (interquartile range, 99 minutes); and baseline imaging to groin puncture, 86 minutes (interquartile range, 24 minutes). Time from baseline imaging to puncture was prolonged in patients receiving intravenous tissue-type plasminogen activator (32-minute mean delay) and when magnetic resonance-based imaging at baseline was used (18-minute mean delay). Extracranial carotid disease delayed puncture to first stent deployment time on average by 25 minutes. For each 1-hour increase in stroke onset to final digital subtraction angiography (or TICI 2b/3) time, odds of good clinical outcome decreased by 38%. Conclusions-Interval times in the STAR study reflect current intra-arterial therapy for patients with acute ischemic stroke.Improving workflow metrics can further improve clinical outcome. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01327989.

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Section: Discussionmentioning

confidence: 99%

Optimal Workflow and Process-Based Performance Measures for Endovascular Therapy in Acute Ischemic Stroke

Menon

Almekhlafi

Pereira

et al. 2014

Stroke

143

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“…24 In consideration of that point, defining the optimal timeframe for reperfusion based on collateral-flow adequacy is crucial in averting further ischemic injury. 25,26 Our study demonstrated that the evaluation of the collateral-flow status before the initiation of intra-arterial treatment could be a key marker to determine a timeframe for reperfusion with a probable favorable clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

Impact of Time-to-Reperfusion on Outcome in Patients with Poor Collaterals

Hwang

Kang²,

Kim³

et al. 2014

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:The relationship between reperfusion and clinical outcome is time-dependent, and the effect of reperfusion on outcome can vary on the basis of the extent of collateral flow. We aimed to identify the impact of time-to-reperfusion on outcome relative to baseline angiographic collateral grade in patients successfully treated with endovascular revascularization for acute large-vessel anterior circulation stroke.

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“…7,8 We recently proposed a methodology for the documentation of INT after the endovascular procedure. 6 This classification takes into account variations in vascular anatomy and the location of the thrombus, using information on the preprocedure noninvasive vascular imaging, end-of-procedure angiography images, and the location of infarcts on follow-up imaging.…”

Section: Strokementioning

confidence: 99%

Infarct in a New Territory After Treatment Administration in the ESCAPE Randomized Controlled Trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times)

Ganesh

Al-Ajlan

Sabiq

et al. 2016

Stroke

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Background and Purpose-Infarct in a new previously unaffected territory (INT) is a potential complication of endovascular treatment. We applied a recently proposed methodology to identify and classify INTs in the ESCAPE randomized controlled trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times). Methods-The core laboratory identified INTs on 24-hour follow-up imaging, blinded to treatment allocation, after assessing all baseline imaging. INTs were classified into 3 types (I-III) and 2 subtypes (A/B) based on size and if catheter manipulation was likely performed across the vessel territory ostium. Logistic regression was used to understand the effect of multiple a priori identified variables on INT occurrence. Ordinal logistic regression was used to analyze the effect of INTs on modified Rankin Scale shift at 90 days. Results-From 308 patients included, 14 INTs (4.5% overall; 2.8% on follow-up noncontrast computed tomography, 11.7% on follow-up magnetic resonance imaging) were identified (5.0% in endovascular treatment arm versus 4.0% in control arm [P=0.7]). The use of intravenous alteplase was associated with a 68% reduction in the odds of INT occurrence (3.0% with versus 9.1% without; odds ratio, 0.32; 95% confidence interval, 0.11-0.96; adjusted for age, sex, and treatment type). No other variables were associated with INTs. INT occurrence was associated with reduced probability of good clinical outcome (common odds ratio, 0.25; 95% confidence interval, 0.09-0.74; adjusted for age, type of treatment, and follow-up scan). Conclusions-INTs are uncommon, detected more frequently on follow-up magnetic resonance imaging, and affect clinical outcome. In experienced centers, endovascular treatment is likely not causal, whereas intravenous alteplase may be therapeutic.

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Developing practice recommendations for endovascular revascularization for acute ischemic stroke

Cited by 26 publications

References 62 publications

Optimal Workflow and Process-Based Performance Measures for Endovascular Therapy in Acute Ischemic Stroke

Optimal Workflow and Process-Based Performance Measures for Endovascular Therapy in Acute Ischemic Stroke

Impact of Time-to-Reperfusion on Outcome in Patients with Poor Collaterals

Infarct in a New Territory After Treatment Administration in the ESCAPE Randomized Controlled Trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times)

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