Article
Author: Galvano, Gianluca ; Cioni, Samuele ; Boghi, Andrea ; Boero, Giovanni ; D’Agostino, Federica ; Naldi, Andrea ; Lafe, Elvis ; Vinci, Sergio Lucio ; Alemseged, Fana ; Diomedi, Marina ; Petruzzellis, Marco ; Gallesio, Ivan ; Giossi, Alessia ; Ciacciarelli, Antonio ; Toni, Danilo ; Cappellari, Manuel ; Mascolo, Alfredo Paolo ; Cavasin, Nicola ; De Vito, Alessandro ; Puglielli, Edoardo ; Lacidogna, Giordano ; Mangiafico, Salvatore ; De Santis, Federica ; Merlino, Giovanni ; Coco, Elena ; Carità, Giuseppe ; Vallone, Stefano ; Zimatore, Domenico Sergio ; Bigliardi, Guido ; Semeraro, Vittorio ; Ferrandi, Delfina ; Mannino, Marina ; Comai, Alessio ; Besana, Michele ; Sabuzi, Federico ; Sallustio, Fabrizio ; Zini, Andrea ; Limbucci, Nicola ; Caggiula, Marcella ; Longoni, Marco ; Fainardi, Enrico ; Allegretti, Luca ; Caproni, Stefano ; Menozzi, Roberto ; Bergui, Mauro ; Critelli, Adriana ; Galluzzo, Simone ; Nicolini, Ettore ; Petralia, Benedetto ; Sponza, Massimo ; Casetta, Ilaria ; Zilahi De Gyurgyokai, Simone ; Saletti, Andrea ; Barchetti, Giovanni ; Dall’Ora, Elisa ; Pezzini, Alessandro ; Giannini, Nicola ; Marrama, Federico ; Saracco, Eleonora ; Bosco, Giovanni ; Allegritti, Massimiliano ; Loizzo, Nicola ; Perri, Marco ; Ferraù, Ludovica ; Napoletano, Rosa ; Russo, Monia ; Tassi, Rossana ; Filizzolo, Marco ; Da Ros, Valerio ; Cosottini, Mirco ; Casalena, Alfonsina
Introduction:We aim to evaluate the association between door-to-needle time (DTN) and outcomes in a population of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) + mechanical thrombectomy (MT) in the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS).
Materials and methods:Patients with AIS secondary to middle cerebral artery or intracranial internal carotid artery occlusion with known times of symptoms onset, directly presenting to an MT-capable center, were included in the analysis. According to pre-defined DTN cut-off values (⩽30, ⩽45, and ⩽60 min), we evaluated the association between DTN and outcomes by multivariate logistic regression analyses. Effectiveness outcomes were 3-month functional independence, 3-month excellent outcome and successful reperfusion. Safety outcomes were any intracranial hemorrhage (ICH), symptomatic intracerebral hemorrhage (sICH), and 3-month mortality.
Results:About 1602 patients were included in our analysis. After logistic regression analysis, a DTN ⩽ 60 min was significantly associated with 3-month functional independence (OR 1.36; 95% CI 1.02–1.82). DTNs ⩽ 30, ⩽45, and ⩽60 min were significantly associated with successful reperfusion (OR 2.66; 95% CI 1.6–4.43; OR 1.68; 95%CI 1.25-2.26; OR 1.57; 95% CI 1.21–2.05; respectively). A DTN ⩽ 60 min was also significantly associated with lower rate of any ICH (OR 0.61; 95% CI 0.43–0.86). DTNs ⩽ 30, ⩽45, and ⩽60 min were significantly associated with lower 3-month mortality (OR 0.24; 95% CI 0.08–0.67; OR 0.45; 95% CI 0.29–0.72; OR 0.58; 95% CI 0.39–0.84; respectively).
Conclusions:In patients with AIS treated with IVT + MT, a shorter DTN is associated with better outcomes if IVT is initiated within 1 h of hospital admission.