title: Stagnation of treatment times over a decade: results of a pooled analysis from the MERCI registry, MERCI, TREVO, and TREVO 2 trials.
abstract: BACKGROUND
  There has been a growing interest in improving systems of care for the endovascular treatment of acute ischemic stroke. We analyzed data from previous registries and studies to determine if there has been an improvement in times to reperfusion with increasing experience.
  
  
  METHODS
  We analyzed the pooled data from the Multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI), MERCI Registry and Thrombectomy Revascularization of Large Vessel Occlusions (TREVO), and TREVO 2 trials and assessed times from last known normal to puncture, from hospital arrival to puncture, and procedure duration by year to determine if there has been a reduction in times. Demographic, radiographic, and clinical information were also assessed in a multivariate regression analysis to determine the predictors of good outcomes defined as a modified Rankin Scale score of 0-2 at 3 months.
  
  
  RESULTS
  1248 patients of mean age 68±14 years and median NIH Stroke Scale score 18 were analyzed from 2001 to 2011. Procedure times showed a significant improvement while last known normal to puncture times remained static. In multivariate logistic regression analysis, longer last known normal to puncture time and longer procedure duration were associated with a decreased chance of a good outcome (OR 0.84, 95% CI 0.76 to 0.92, p=0.0004 and OR 0.75, 95% CI 0.61 to 0.91, p=0.0040, respectively).
  
  
  CONCLUSIONS
  Despite a reduction in procedure times, there has not been a corresponding improvement in overall last known normal to puncture times over a 10-year period. The current study shows that there are many opportunities to create more efficient endovascular stroke systems of care in trials.
authors: Wellstar Neurosciences Network, Wellstar Medical Group Neurosurgery, Marietta, Georgia, USA.
authors: Rishi
authors: R
authors: Gupta
authors: Prospect Analytical, San Jose, California, USA.
authors: Bin
authors: B
authors: Xiang
authors: Stryker Neurovascular, Fremont, California, USA.
authors: Sijian
authors: S
authors: Ge
authors: Department of Neurology, Columbia Presbyterian Medical Center, New York, USA.
authors: Chung-Huan J
authors: CH
authors: Sun
authors: Department of Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors: Albert J
authors: AJ
authors: Yoo
authors: Neurointerventional Surgery, Memorial Health System, Hollywood, Florida, USA.
authors: Brijesh P
authors: BP
authors: Mehta
mesh_terms: D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D002548:Cerebral Revascularization / Q000379:methods / Q000639:trends; D002986:Clinical Trials as Topic / Q000379:methods; D006801:Humans; D012042:Registries; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods / Q000639:trends; D013997:Time Factors; D061665:Time-to-Treatment / Q000639:trends*; D016896:Treatment Outcome
keywords: Stroke; Thrombectomy