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. 2024 Aug;271(8):5203-5212.
doi: 10.1007/s00415-024-12458-2. Epub 2024 Jun 5.

Association between procedural time and outcome in unsuccessful mechanical thrombectomy for acute ischemic stroke: analysis from the Italian Registry of Endovascular Treatment in Acute Stroke

Fabrizio Sallustio  1   2 , Ettore Nicolini  3 , Valentina Saia  4 , Giovanni Pracucci  5 , Alfredo Paolo Mascolo  6 , Federico Marrama  6 , Roberto Gandini  6 , Valerio Da Ros  6 , Marina Diomedi  6 , Fana Alemseged  7 , Ilaria Casetta  8 , Enrico Fainardi  9 , Lucio Castellan  10 , Massimo Del Sette  11 , Nicola Limbucci  12 , Patrizia Nencini  13 , Mauro Bergui  14 , Paolo Cerrato  15 , Andrea Saletti  16 , Alessandro De Vito  17 , Samuele Cioni  18 , Rossana Tassi  19 , Luigi Simonetti  20 , Andrea Zini  21 , Maria Ruggiero  22 , Marco Longoni  23 , Agostino Tessitore  24 , Ludovica Ferraù  25 , Nicola Cavasin  26 , Adriana Critelli  27 , Stefano Vallone  28 , Guido Bigliardi  29 , Domenico Sergio Zimatore  30 , Marco Petruzzellis  31 , Andrea Boghi  32 , Andrea Naldi  33 , Alessio Comai  34   35 , Elisa Dall'Ora  35   36 , Giuseppina Sanfilippo  37 , Alessandra Persico  38 , Ivan Gallesio  39 , Federica Sepe  40 , Roberto Menozzi  41 , Alessandro Pezzini  42   43 , Michele Besana  44 , Alessia Giossi  45 , Antioco Sanna  46 , Tiziana Tassinari  47 , Nicola Burdi  48 , Giovanni Boero  49 , Raffaele Augelli  50 , Manuel Cappellari  51 , Mirco Cosottini  52 , Nicola Giannini  53 , Daniele G Romano  54 , Giulia Frauenfelder  55 , Paolo Nunzio Nuzzi  56 , Maria Carmela Spinelli  57 , Adriana Paladini  58 , Annalisa Rizzo  59 , Marco Filizzolo  60 , Marina Mannino  61 , Carmine Timpani  62 , Federica De Santis  63 , Giuseppe Carità  64 , Monia Russo  65 , Gianluca Galvano  66 , Luigi Sicurella  67 , Salvatore Mangiafico  68 , Danilo Toni  69 ; Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) Collaborators
Affiliations

Association between procedural time and outcome in unsuccessful mechanical thrombectomy for acute ischemic stroke: analysis from the Italian Registry of Endovascular Treatment in Acute Stroke

Fabrizio Sallustio et al. J Neurol. 2024 Aug.

Abstract

Background: We aim to assess the association between procedural time and outcomes in patients in unsuccessful mechanical thrombectomy (MT) for anterior circulation acute stroke.

Methods: We conducted a cohort study on prospectively collected data from patients with M1 and/or M2 segment of middle cerebral artery occlusion with a thrombolysis in cerebral infarction 0-1 at the end of procedure. Primary outcome was 90-day poor outcome. Secondary outcomes were early neurological deterioration (END), symptomatic intracranial hemorrhage (sICH) according to ECASS II and sICH according to SITS-MOST.

Results: Among 852 patients, after comparing characteristics of favourable and poor outcome groups, logistic regression analysis showed age (OR: 1.04; 95%CI: 1.02-1.05; p < 0.001), previous TIA/stroke (OR: 0.23; 95%CI: 0.12-0.74; p = 0.009), M1 occlusion (OR: 1.69; 95%CI: 1.13-2.50; p = 0.01), baseline NIHSS (OR: 1.01; 95%CI: 1.06-1.13; p < 0.001) and procedural time (OR:1.00; 95% CI: 1.00-1.01; p = 0.003) as independent predictors poor outcome at 90 days. Concerning secondary outcomes, logistic regression analysis showed NIHSS (OR:0.96; 95%CI: 0.93-0.99; p = 0.008), general anaesthesia (OR:2.59; 95%CI: 1.52-4.40; p < 0.001), procedural time (OR: 1.00; 95% CI: 1.00-1.01; p = 0.002) and intraprocedural complications (OR: 1.89; 95%CI: 1.02-3.52; p = 0.04) as independent predictors of END. Bridging therapy (OR:2.93; 95%CI: 1.21-7.09; p = 0.017) was associated with sICH per SITS-MOST criteria whereas M1 occlusion (OR: 0.35; 95%CI: 0.18-0.69; p = 0.002), bridging therapy (OR: 2.02; 95%CI: 1.07-3.82; p = 0.03) and intraprocedural complications (OR: 5.55; 95%CI: 2.72-11.31; p < 0.001) were independently associated with sICH per ECASS II criteria. No significant association was found between the number of MT attempts and analyzed outcomes.

Conclusions: Regardless of the number of MT attempts and intraprocedural complications, procedural time was associated with poor outcome and END. We suggest a deeper consideration of procedural time when treating anterior circulation occlusions refractory to MT.

Keywords: Acute stroke; Clinical outcome; Procedural time; Unsuccessful thrombectomy.

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