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Updated: May 7, 2026
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
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Does symptom onset to primary stroke center time goals affect stroke outcome?
Bryant Chee1, Rema Raman2, Karin Ernstrom2
1University of California San Diego Neurosciences Department.
Summary
Time goals for acute ischemic stroke (AIS) patients arriving at a Primary Stroke Center (PSC) did not predict 90-day outcomes. Expedited care processes may be key to optimizing recovery in stroke patients.
Area of Science:
- Neurology
- Emergency Medicine
- Public Health
Background:
- Optimizing recovery in acute ischemic stroke (AIS) patients involves rapid treatment, typically within 4.5 hours of symptom onset and a door-to-needle time under 60 minutes.
- The impact of symptom onset to Primary Stroke Center (PSC) arrival time goals on patient outcomes remains unclear.
Purpose of the Study:
- To investigate the effect of symptom onset to PSC time goals on the 90-day outcomes of AIS patients.
Main Methods:
- Analysis of prospectively collected data from AIS patients treated with intravenous recombinant tissue plasminogen activator within 270 minutes.
- Assessment of 90-day modified Rankin Scale (mRS) scores using multivariable logistic regression, defining good outcome as mRS 0-2.
- Evaluation of variables including onset to arrival time, stroke code activation, and treatment decision times, analyzed by quartiles.
Main Results:
- Among 291 AIS patients, 45% achieved a good 90-day outcome.
- No significant differences were observed in mean onset to arrival (70.6 vs. 62.5 min) or onset to treatment times (140.1 vs. 134.9 min) between good and poor outcome groups.
- After controlling for covariates, no PSC time goals emerged as significant predictors of 90-day outcomes.
Conclusions:
- Onset to PSC time goals were not significant predictors of 90-day outcomes in this Comprehensive Stroke Center (CSC) cohort.
- Efficient care processes within CSCs may mitigate the impact of initial time metrics on patient recovery.
- Further validation in larger cohorts and comparisons between PSCs and CSCs are recommended.
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