Procedure Time of Endovascular Thrombectomy as Performance Measure of Acute Stroke Treatment

Abstract

Purpose: Procedure time (PT), defined as the time between groin access and vessel recanalization, is a recently recognized predictor of outcomes after endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). However, the factors affecting PT and its potential value as a performance measure of AIS treatment remain unexplored. Materials and Methods: Using the Korean Stroke Registry, we compared patients who underwent EVT for AIS from 2018 to 2022 based on 60 minutes PT. We conducted multivariate analysis to investigate whether PT <60 minutes was associated with successful recanalization and good functional stroke outcomes. We also investigated factors that independently predicted PT >_60 minutes. Furthermore, we determined the cutoff point for PT. Results: We analyzed 4,703 patients (mean age: 69.5 +/- 11.9, 60.3% male) who underwent EVT. The mean PT was 54.6 +/- 36.7 minutes. Multivariate analysis revealed that PT <60 minutes independently predicted a good functional outcome as represented by modified Rankin Scale scores of 0-2 (adjusted odds ratio [aOR]: 1.40, 95% confidence interval [CI]: 1.22-1.59). PT <60 minutes was significantly associated with successful recanalization after adjusting for confounding variables (aOR: 1.66, 95% CI: 1.33-2.07). Moreover, after adjusting for covariates, age>_65 years (aOR: 1.20, 95% CI: 1.05-1.38), onset-to-door time (aOR: 1.03, 95% CI: 1.01-1.04), door-to-puncture time (aOR: 1.05, 95% CI: 1.03-1.06), posterior circulation stroke (PCS) (aOR: 1.13, 95% CI: 1.02-1.28), and smoking (aOR: 1.24, 95%CI: 1.09-1.45) independently predicted PT >_60 minutes. Finally, the highest aOR for good stroke outcome was observed in the 60-minute cutoff model (aOR: 1.45, 95%CI: 1.27-1.67). Conclusion: PT <60 minutes was significantly associated with good functional outcomes. Conversely, PT >_60 minutes was associated with older age, PCS, smoking, prolonged onset-to-door and door-to-puncture time. Further studies are necessary to develop refining strategies for optimizing PT to improve stroke outcomes.