Procedure time and clinical outcomes after thrombectomy: a pooled cohort analysis of three randomised trials

Procedure time (PT) during endovascular thrombectomy (EVT) may be associated with clinical outcomes in acute ischaemic stroke (AIS). We evaluated the association between PT and clinical outcomes using a large pooled analysis.

We performed a post hoc analysis of 3 multicentre randomised controlled trials including patients with anterior circulation large-vessel occlusion treated with EVT in China (2018-2023). The primary outcome was a favourable outcome (mRS, 0-2) at 90 days; the secondary outcomes were excellent outcome (mRS 0-1), sICH and all-cause mortality. Procedure time was evaluated as a continuous variable (per 10-min increase) and in categories (≤60, 60-120, > 120 min) using adjusted logistic and mixed-effects models.

Among 2845 eligible patients (median age 68 years, 57.4% were male, median PT 69 min), each 10-min increase in PT was associated with an adjusted risk difference (aRD) of -1.52% (95% CI, -1.85% to -1.20%) in the probability of achieving mRS 0-2 and an aRD of 0.77% (95% CI, 0.53%-1.01%) increase in mortality, corresponding to lower odds of mRS 0-2 (aOR 0.928; 95% CI, 0.912-0.944) and higher odds of sICH (aOR 1.028; 95% CI, 1.007-1.049) and mortality (aOR 1.055; 95% CI, 1.037-1.073). Compared with PT ≤ 60 min, PT 60-120 and > 120 min were associated with reduced odds of mRS 0-2 (aOR 0.658 and 0.355, respectively) and increased mortality (aOR 1.648 and 2.422, respectively). These associations were consistent across sensitivity analyses. In exploratory mediation analyses, total passes and the first pass effect (FPE) explained only 12.9% and 11.4% of the association between PT and favourable outcome, respectively.

Prolonged PT during EVT was associated with a reduced rate of favourable outcomes and increased sICH and mortality. These findings support continued efforts to minimise avoidable intraprocedural delays during EVT.