Procedure time and 90-day outcomes after endovascular thrombectomy for large-core stroke

Procedure time during endovascular thrombectomy (EVT) has been associated with outcomes in general thrombectomy cohorts, but whether this relationship reflects a threshold or continuous risk accumulation in large-core stroke remains unclear.

We performed a retrospective observational analysis of 490 patients with anterior-circulation large-vessel occlusion (LVO) and large-core infarction, defined by an Alberta Stroke Program Early Computed Tomography Score of 5 or less, from a prospective multicentre registry across 38 centres. Procedure time was analysed categorically and continuously. The primary outcome was the 90-day mRS score of 0-3. Secondary outcomes were 90-day mortality and sICH. Restricted cubic splines tested nonlinearity.

Each 10-min increase in procedure time was associated with lower odds of an modified Rankin Scale (mRS) score of 0-3 (odds ratio, 0.91; 95% CI, 0.86-0.95) and higher mortality (odds ratio, 1.07; 95% CI, 1.02-1.11). On the absolute scale, the marginally standardised probability of mRS 0-3 decreased from 44.5% at 60 min to 27.5% at 150 min (absolute risk difference - 17.1 percentage points; 95% CI, - 27.7 to -6.4). Spline analyses showed no evidence of nonlinearity for functional outcome or mortality. No consistent association with sICH was observed across analyses.

Longer procedure time was associated with progressively worse functional outcome and higher mortality in large-core EVT, without evidence of a clear nonlinear inflection point.

These findings support procedure time as a continuous intraprocedural risk indicator that may inform ongoing procedural reassessment.

MAGIC registry, ChiCTR.org.cn Identifier: ChiCTR2100051664.