title: Complete reperfusion mitigates influence of treatment time on outcomes after acute stroke.
abstract: BACKGROUND
  Time to reperfusion following endovascular treatment (ET) predicts outcomes after acute ischemic stroke (AIS).
  
  
  OBJECTIVE
  To assess the time-outcome relationship within reperfusion grades in the North American Solitaire Acute Stroke registry.
  
  
  METHODS
  We identified patients given ET for anterior circulation ischemic stroke within 8 h from onset and in whom reperfusion was achieved. Together with clinical and outcome data, site-adjudicated modified Thrombolysis in Cerebral Ischemia (TICI) was recorded. We assessed the impact of time to reperfusion (onset to procedure completion time) on good outcome (modified Rankin Scale 0-2 at 3 months) in patients who achieved TICI 2 or higher reperfusion in multivariable models. We further assessed this relationship within strata of reperfusion grades. A p<0.05 was considered significant.
  
  
  RESULTS
  Independent predictors of good outcome at 3 months among those achieving TICI ≥2a reperfusion (n=188) were initial National Institutes of Health Stroke Scale score (adjusted OR=0.90, 95% CI 0.85 to 0.95), symptomatic hemorrhage (adj. OR=0.16, 95% CI 0.05 to 0.60), TICI grade (TICI 3: adj. OR=11.52, 95% CI 3.34 to 39.77; TICI 2b: adj. OR=5.14, 95% CI 1.61 to 16.39), and time to reperfusion per 30 min interval (adj. OR=0.91, 95% CI 0.82 to 0.99). There was an interaction between final TICI grade and 30 min time to reperfusion intervals (p=0.001) such that the effect of time was strongest in TICI 2a patients.
  
  
  CONCLUSIONS
  Time to reperfusion was a strong predictor of outcome following ET for AIS. However, the effect varied by TICI grade such that its greatest effect was in those achieving TICI 2a reperfusion.
authors.affiliation: Northwestern University, Chicago, Illinois, USA.
authors.forename: Shyam
authors.initials: S
authors.lastname: Prabhakaran
authors.affiliation: University of Texas, MD Anderson, Houston, Texas, USA.
authors.forename: Alicia C
authors.initials: AC
authors.lastname: Castonguay
authors.affiliation: Wellstar Neurosurgery Kennestone Hospital, Atlanta, Georgia, USA.
authors.forename: Rishi
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Chung-Huan J
authors.initials: CJ
authors.lastname: Sun
authors.affiliation: Saint Luke's Kansas City, Kansas City, Missouri, USA.
authors.forename: Coleman O
authors.initials: CO
authors.lastname: Martin
authors.affiliation: Saint Luke's Kansas City, Kansas City, Missouri, USA.
authors.forename: William
authors.initials: W
authors.lastname: Holloway
authors.affiliation: Delray Medical Center, Delray Beach, Florida, USA.
authors.forename: Nils H
authors.initials: NH
authors.lastname: Mueller-Kronast
authors.affiliation: California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Joey
authors.initials: J
authors.lastname: English
authors.affiliation: Baptist Cardiac and Vascular Institute, Miami, Florida, USA.
authors.forename: Italo
authors.initials: I
authors.lastname: Linfante
authors.affiliation: Baptist Cardiac and Vascular Institute, Miami, Florida, USA.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Dabus
authors.affiliation: Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA.
authors.forename: Tim
authors.initials: T
authors.lastname: Malisch
authors.affiliation: Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA.
authors.forename: Franklin
authors.initials: F
authors.lastname: Marden
authors.affiliation: Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: Hormozd
authors.initials: H
authors.lastname: Bozorgchami
authors.affiliation: Wayne State University School of Medicine, Detroit, Michigan, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Xavier
authors.affiliation: West Virginia University Hospital, Morgantown, West Virginia, USA.
authors.forename: Ansaar
authors.initials: A
authors.lastname: Rai
authors.affiliation: West Virginia University Hospital, Morgantown, West Virginia, USA.|Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Froehler
authors.affiliation: Provena Saint Joseph Medical Center, Joliet, Illinois, USA.
authors.forename: Aamir
authors.initials: A
authors.lastname: Badruddin
authors.affiliation: Desert Regional Medical Center, Palm Springs, California, USA.
authors.forename: Mohammad Asif
authors.initials: MA
authors.lastname: Taqi
authors.affiliation: University of Texas Southwestern Medical Center, USA.
authors.forename: Roberta
authors.initials: R
authors.lastname: Novakovic
authors.affiliation: University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Abraham
authors.affiliation: Texas Stroke Institute, Plano, Texas, USA.
authors.forename: Vallabh
authors.initials: V
authors.lastname: Janardhan
authors.affiliation: University of Texas Health Science Center, Houston, Texas, USA.
authors.forename: Hashem
authors.initials: H
authors.lastname: Shaltoni
authors.affiliation: Texas Stroke Institute, Plano, Texas, USA.
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Yoo
authors.affiliation: Texas Stroke Institute, Plano, Texas, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Abou-Chebl
authors.affiliation: University of Texas Health Science Center, Houston, Texas, USA.
authors.forename: Peng
authors.initials: P
authors.lastname: Chen
authors.affiliation: Methodist Neurological Institute, Houston, Texas, USA.
authors.forename: Gavin
authors.initials: G
authors.lastname: Britz
authors.affiliation: Saint Louis University, St Louis, Missouri, USA.
authors.forename: Ritesh
authors.initials: R
authors.lastname: Kaushal
authors.affiliation: University of Missouri, Columbia, Missouri, USA.
authors.forename: Ashish
authors.initials: A
authors.lastname: Nanda
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Raul
authors.initials: R
authors.lastname: Nogueira
authors.affiliation: Boston Medical Center, Boston, Massachusetts, USA.
authors.forename: Thanh
authors.initials: T
authors.lastname: Nguyen
authors.affiliation: St Vincent Mercy Medical Center, Toledo, Ohio, USA.
authors.forename: Osama O
authors.initials: OO
authors.lastname: Zaidat
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D002545:Brain Ischemia / Q000503:physiopathology* / Q000628:therapy; D002544:Cerebral Infarction / Q000503:physiopathology* / Q000628:therapy*; D015331:Cohort Studies; D004185:Disability Evaluation; D061345:Early Medical Intervention; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D015424:Reperfusion / Q000295:instrumentation* / Q000379:methods*; D012189:Retrospective Studies; D020521:Stroke / Q000503:physiopathology* / Q000628:therapy*; D017131:Thrombectomy / Q000295:instrumentation* / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Device; Stroke; Thrombectomy