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Meta-Analysis
. 2019 Apr 1;76(4):405-411.
doi: 10.1001/jamaneurol.2018.4510.

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

Romain Bourcier  1 , Mayank Goyal  2 , David S Liebeskind  3 , Keith W Muir  4 , Hubert Desal  1 , Adnan H Siddiqui  5 , Diederik W J Dippel  6 , Charles B Majoie  7 , Wim H van Zwam  8 , Tudor G Jovin  9 , Elad I Levy  5 , Peter J Mitchell  10 , Olvert A Berkhemer  7 , Stephen M Davis  10 , Imad Derraz  11 , Geoffrey A Donnan  12 , Andrew M Demchuk  2 , Robert J van Oostenbrugge  8 , Michael Kelly  13 , Yvo B Roos  7 , Reza Jahan  3 , Aad van der Lugt  6 , Marieke Sprengers  7 , Stephane Velasco  14 , Geert J Lycklama À Nijeholt  15 , Wagih Ben Hassen  16 , Paul Burns  17 , Scott Brown  18 , Emmanuel Chabert  19 , Timo Krings  20 , Hana Choe  21 , Christian Weimar  22 , Bruce C V Campbell  10 , Gary A Ford  23 , Marc Ribo  24 , Phil White  25 , Geoffrey C Cloud  26 , Luis San Roman  27 , Antoni Davalos  28 , Olivier Naggara  16 , Michael D Hill  2 , Serge Bracard  29 ; HERMES Trialists Collaboration
Affiliations
Meta-Analysis

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

Romain Bourcier et al. JAMA Neurol. .

Erratum in

  • Error in Author Byline.
    [No authors listed] [No authors listed] JAMA Neurol. 2019 Jul 1;76(7):872. doi: 10.1001/jamaneurol.2019.1501. JAMA Neurol. 2019. PMID: 31135818 Free PMC article. No abstract available.

Abstract

Importance: Reperfusion is a key factor for clinical outcome in patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT) for large-vessel intracranial occlusion. However, data are scarce on the association between the time from onset and reperfusion results.

Objective: To analyze the rate of reperfusion after EVT started at different intervals after symptom onset in patients with AIS.

Design, setting, and participants: We conducted a meta-analysis of individual patient data from 7 randomized trials of the Highly Effective Reperfusion Using Multiple Endovascular Devices (HERMES) group. This is a multicenter cohort study of the intervention arm of randomized clinical trials included in the HERMES group. Patients with anterior circulation AIS who underwent EVT for M1/M2 or intracranial carotid artery occlusion were included. Each trial enrolled patients according to its specific inclusion and exclusion criteria. Data on patients eligible but not enrolled (eg, refusals or exclusions) were not available. All analyses were performed by the HERMES biostatistical core laboratory using the pooled database. Data were analyzed between December 2010 and April 2015.

Main outcomes and measures: 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) using mixed-methods logistic regression.

Results: Among the 728 included patients, with a mean (SD) age of 65.4 (13.5) years and of whom 345 were female (47.4%), decreases in rates of successful reperfusion defined as a thrombolysis in cerebral infarction score of 2b/3 were observed with increasing time from admission or first imaging to groin puncture. 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.

Conclusions and relevance: Because the probability of reperfusion declined significantly with time between hospital arrival and groin puncture, we provide additional arguments for minimizing the intervals after symptom onset in anterior circulation acute ischemic stroke.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Berkhemer reports other fees from Stryker outside the submitted work (institutional disclosure). Dr Brown reports personal fees from University of Calgary during the conduct of the study and from Medtronic outside the submitted work. Dr Burns reports grants from University of Calgary during the conduct of the study. Dr Davalos reports grants and personal fees from Medtronic during the conduct of the study and personal fees from Medtronic outside the submitted work. Dr Demchuk reports grants and personal fees from Medtronic during the conduct of the study. Dr Ford reports grants and personal fees from Medtronic and Pfizer; and personal fees from Stryker, Daiichi Sankyo, and Amgen; other fees from Pulse Therapeutics; and grants from Bristol Myers Squibb outside the submitted work. Dr Jahan reports personal fees from Medtronic Neurovascular during the conduct of the study and outside the submitted work. Dr Jovin reports involvement with Anaconda, Route 92, FreeOx Biotech, Blockade Medical, and Silk Road, and nonfinancial support from Stryker outside the submitted work. Dr Kelly reports other from Medtronic Inc and support from Penumbra Inc outside the submitted work. Dr Levy reports other fees from nExTgEn Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care, Rebound Therapeutics, StimMed, and Three Rivers Medical; personal fees from Medtronic, Claret Medical, GLG Consulting, Guidepoint Global, Imperative Care, Rebound Therapeutics; nonfinancial support from Stryker, NeXtGen Biologics, MEDX, Cognition Medical, and Expert Witness outside the submitted work; and was the National PI for SWIFT Prime and SWIFT Direct Trials. Dr Ribo reports personal fees from Anaconda Biomed during the conduct of the study. Dr Siddiqui reports personal fees from Amnis Therapeutics, Apama Medical, BlinkTBI Inc, Buffalo Technology Partners Inc, Cardinal Health, Cerebrotech Medical Systems Inc, Claret Medical, Cognition Medical, Endostream Medical Ltd, Imperative Care, International Medical Distribution, Partners, Rebound Therapeutics Corp, Rist Neurovascular Inc, Serenity Medical, Inc., Silk Road, Medical, StimMed, Synchron, Three Rivers Medical Inc, Viseon Spine Inc, Amnis Therapeutics, Boston Scientific, Canon Medical Systems USA Inc, Cerebrotech Medical Systems Inc, Cerenovus, Claret Medical, Corindus Inc, Endostream Medical Ltd, Guidepoint Global Consulting, Imperative Care, Integra, Medtronic, MicroVention, Northwest University-DSMB Chair for HEAT Trial, Penumbra, Rapid Medical, Rebound Therapeutics Corp, Serenity Medical Inc, Silk Road Medical, StimMed, Stryker, Three Rivers Medical Inc, VasSol, W.L. Gore and Associates, the Cerenovus LARGE Trial and ARISE II Trial, Medtronic SWIFT PRIME and SWIFT DIRECT Trials; MicroVention FRED Trial and CONFIDENCE Study, MUSCPOSITIVE Trial; Penumbra 3D Separator Trial, COMPASS Trial, and the INVEST Trial outside the submitted work. Dr van der Lugt reports grants from Dutch Heart Foundation, Angiocare, Stryker, Top Medical Concentric, Medtronic/Covidien/EV3, and Medac GmbH/Lamepro during the conduct of the study and grants from Stryker, Penumbra, and Medtronic outside the submitted work. Dr White reports grants from Microvention, and personal fees from Stryker and Microvention outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Flowchart
EVT indicates endovascular treatment; ICA, intracranial carotid artery; M1/M2, first and second segment of the middle cerebral artery; TICI, thrombolysis in cerebral infarction.
Figure 2.
Figure 2.. Modeled Probability of Thrombolysis in Cerebral Infarction (TICI) Score of 2b/3 by Workflow Time
Modeled probabilities of TICI score of 2b/3 outcome by workflow time, computed using logistic regression with covariates analogous to those in Table 2. Results are displayed as the point estimate for probability of TICI 2b/3 modeled by time along with the corresponding 95% confidence interval. ED indicates emergency department.
See this image and copyright information in PMC

References

    1. Goyal M, Menon BK, van Zwam WH, et al. ; HERMES collaborators . Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723-1731. doi:10.1016/S0140-6736(16)00163-X - DOI - PubMed
    1. Saver JL, Goyal M, van der Lugt A, et al. ; HERMES Collaborators . Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA. 2016;316(12):1279-1288. doi:10.1001/jama.2016.13647 - DOI - PubMed
    1. Manning NW, Chapot R, Meyers PM. Endovascular stroke management: key elements of success. Cerebrovasc Dis. 2016;42(3-4):170-177. doi:10.1159/000445449 - DOI - PubMed
    1. Rha J-H, Saver JL. The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke. 2007;38(3):967-973. doi:10.1161/01.STR.0000258112.14918.24 - DOI - PubMed
    1. Higashida R, Furlan A, Roberts H, et al. ; Technology Assessment Committees of the American Society of Interventional and Therapeutic Neuroradiology and the Society of Interventional Radiology . Trial design and reporting standards for intraarterial cerebral thrombolysis for acute ischemic stroke. J Vasc Interv Radiol. 2003;14(9 Pt 2):S493-S494. - PubMed

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