title: Time to endovascular reperfusion and degree of disability in acute stroke.
abstract: OBJECTIVE
  Faster time from onset to recanalization (OTR) in acute ischemic stroke using endovascular therapy (ET) has been associated with better outcome. However, previous studies were based on less-effective first-generation devices, and analyzed only dichotomized disability outcomes, which may underestimate the full effect of treatment.
  
  
  METHODS
  In the combined databases of the SWIFT and STAR trials, we identified patients treated with the Solitaire stent retriever with achievement of substantial reperfusion (Thrombolysis in Cerebral Infarction [TICI] 2b-3). Ordinal numbers needed to treat values were derived by populating joint outcome tables.
  
  
  RESULTS
  Among 202 patients treated with ET with TICI 2b to 3 reperfusion, mean age was 68 (±13), 62% were female, and median National Institutes of Health Stroke Scale (NIHSS) score was 17 (interquartile range [IQR]: 14-20). Day 90 modified Rankin Scale (mRS) outcomes for OTR time intervals ranging from 180 to 480 minutes showed substantial time-related reductions in disability across the entire outcome range. Shorter OTR was associated with improved mean 90-day mRS (1.4 vs. 2.4 vs. 3.3, for OTR groups of 124-240 vs. 241-360 vs. 361-660 minutes; p < 0.001). The number of patients identified as benefitting from therapy with shorter OTR were 3-fold (range, 1.5-4.7) higher on ordinal, compared with dichotomized analysis. For every 15-minute acceleration of OTR, 34 per 1,000 treated patients had improved disability outcome.
  
  
  CONCLUSIONS
  Analysis of disability over the entire outcome range demonstrates a marked effect of shorter time to reperfusion upon improved clinical outcome, substantially higher than binary metrics. For every 5-minute delay in endovascular reperfusion, 1 of 100 patients has a worse disability outcome.
authors.affiliation: Division of Interventional Neuroradiology and Stroke Center, University of California, Los Angeles, CA.
authors.forename: Sunil A
authors.initials: SA
authors.lastname: Sheth
authors.affiliation: Division of Interventional Neuroradiology and Stroke Center, University of California, Los Angeles, CA.
authors.forename: Reza
authors.initials: R
authors.lastname: Jahan
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Gralla
authors.affiliation: Departments of Medical Imaging and Surgery, Toronto Western Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Vitor M
authors.initials: VM
authors.lastname: Pereira
authors.affiliation: Department of Neurology, Emory University, Atlanta, GA.
authors.forename: Raul G
authors.initials: RG
authors.lastname: Nogueira
authors.affiliation: Departments of Neurosurgery and Radiology and Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York.
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
authors.affiliation: Department of Neurology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Osama O
authors.initials: OO
authors.lastname: Zaidat
authors.affiliation: Department of Neurology and Stroke Center, University of California, Los Angeles, CA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities; D057510:Endovascular Procedures / Q000379:methods / Q000639:trends*; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015424:Reperfusion / Q000379:methods / Q000639:trends*; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D013997:Time Factors