Workflow and Outcome of Thrombectomy in Late Time Window: A Pooled Multicenter Analysis.

Area of Science:

• Neurology
• Interventional Radiology
• Public Health

Background:

• Investigated workflow time impact on endovascular thrombectomy (EVT) outcomes in late time window stroke patients.
• Late window defined as onset to imaging >6 hours.

Purpose of the Study:

• To analyze the association between various workflow time intervals and functional independence at 90 days post-EVT.
• To identify critical time points impacting patient outcomes in late window stroke treatment.

Main Methods:

• Pooled individual patient data from seven registries and randomized clinical trials.
• Utilized mixed-effects logistic and negative binomial regression models.
• Analyzed multiple workflow time intervals including ED arrival to imaging, ED arrival to EVT completion, and arterial puncture to EVT completion.

Main Results:

• 608 patients included; 44.9% achieved functional independence (90-day mRS 0-2).
• Each 30-minute delay from ED arrival to imaging decreased functional independence odds by 13%; delay to EVT completion decreased odds by 7%.
• For wake-up stroke patients, delays from arterial puncture to EVT had a significant impact (33% decrease per 30 min).

Conclusions:

• Optimizing workflow, particularly reducing delays from emergency department arrival to EVT completion, is critical for improving functional independence in late window stroke patients.
• Faster procedural times are directly correlated with better patient outcomes in this vulnerable population.