title: Longer procedural times are independently associated with symptomatic intracranial hemorrhage in patients with large vessel occlusion stroke undergoing thrombectomy.
abstract: BACKGROUND
  Time to reperfusion is an essential factor in determination of outcomes in acute ischemic stroke (AIS).
  
  
  OBJECTIVE
  To establish the effect of the procedural time on the clinical outcomes of patients with AIS.
  
  
  METHODS
  Data from all consecutive patients who underwent mechanical thrombectomy between September 2010 and July 2012 were analysed retrospectively. The variable of interest was procedural time (defined as time from groin puncture to final recanalization time). Outcome measures included the rates of symptomatic intracranial hemorrhage (sICH, defined as any parenchymal hematoma-eg, PH-1/PH-2), final infarct volume, 90-day mortality, and independent functional outcomes (modified Rankin Scale 0-2) at 90 days.
  
  
  RESULTS
  The cohort included 242 patients with a mean age of 65.5±14.2 and median baseline National Institutes of Health Stroke Scale score 20. 51% of the patients were female. The mean procedure time was significantly shorter in patients with a good outcome (86.7 vs 73.1 min, respectively, p=0.0228). Patients with SICH had significantly higher mean procedure time than patients without SICH (79.67 vs 104.5 min, respectively; p=0.0319), which remained significant when controlling for the previous factors (OR=0.974, 95% CI 0.957 to 0.991). No correlation was found between the volume of infarction and the procedure time (r=0.10996, p=0.0984). No association was seen between procedure time and 90-day mortality (77.8 vs 88.2 min in survivals vs deaths, respectively; p=0.0958).
  
  
  CONCLUSIONS
  Our data support an association between the risk of SICH and a longer procedure time, but no association between procedural times and the final infarction volume or long-term functional outcomes was found.
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Tareq
authors.initials: T
authors.lastname: Kass-Hout
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.|Catholic Health system, Department of Neuroscience, Buffalo, New York, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Kass-Hout
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.|Columbia University, Department of Neurology New York, New York, USA.
authors.forename: Chung-Huan Johnny
authors.initials: CJ
authors.lastname: Sun
authors.affiliation: Humanitarian Tracker, Washington DC, USA.|Rochester Regional Health System, Department of Neuroscience, Rochester, New York, USA.
authors.forename: Taha A
authors.identifier: http://orcid.org/0000-0002-0123-5157
authors.initials: TA
authors.lastname: Kass-Hout
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Raul
authors.initials: R
authors.lastname: Nogueira
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.|Department of Wellstar Neurosurgery, Kennestone Hospital, Marietta, Georgia, USA.
authors.forename: Rishi
authors.initials: R
authors.lastname: Gupta
keywords: Hemorrhage; Stent; Stroke; Thrombectomy