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    Home » Faster Time to Endovascular Reperfusion Therapy Results in Better Outcomes
    STROKE ALERT

    Faster Time to Endovascular Reperfusion Therapy Results in Better Outcomes

    September 1, 2019
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    Keywords

    stroke

    Hemorrhage

    endovascular

    reperfusion

    By Matthew E. Fink, MD

    Louis and Gertrude Feil Professor and Chair, Department of Neurology; Associate Dean for Clinical Affairs, NewYork Presbyterian/Weill Cornell Medical College

    Dr. Fink reports no financial relationships relevant to this field of study.

    SOURCE: Jahan R, Saver JL, Schwamm LH, et al. Association between time to treatment with endovascular reperfusion therapy and outcomes in patients with acute ischemic stroke treated in clinical practice. JAMA Neurol 2019;322:252-263.

    Endovascular reperfusion therapy has been demonstrated to be of benefit for the treatment of large vessel occlusion in patients with acute ischemic stroke. This effect is time dependent and most of the randomized clinical trials enrolled patients who were no more than eight hours from onset of symptoms to puncture time. These investigators reviewed a real-life cohort of patients who had data recorded in the Get With The Guidelines–Stroke nationwide registry to determine if time to treatment had an effect on clinical outcomes. The database was explored for 6,756 patients with anterior circulation large vessel occlusion during the period January 2015 until December 2016. All patients had onset-to-puncture time of eight hours or less. Main outcomes were substantial reperfusion as determined by the thrombolysis in cerebral infarction (TICI) score of 2b-3, ambulatory status, global disability as determined by the modified Rankin scale, destination at discharge, symptomatic intracranial hemorrhage rate, and in-hospital mortality/hospice discharge. Mean age was 69.5 years, 51% of patients were women, and the median pretreatment score on the NIH stroke scale was 17. In addition, 85.9% of patients achieved substantial reperfusion. Adverse events were symptomatic intracerebral hemorrhage in 6.7% of patients and in-hospital mortality or hospice discharge in 19.6% of patients. At time of hospital discharge, 36.9% of patients were ambulating independently and 23% had functional independence as determined by a modified Rankin score of 0-2.

    Overall, in the 30-270 minute time frame after onset of symptoms, faster onset-to-puncture time, in 15-minute increments, was associated with a higher likelihood of achieving independent function and discharge to home. In addition, faster onset to puncture also was associated with a lower in-hospital mortality or hospice discharge and a lower risk of symptomatic intracerebral hemorrhage.

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    Neurology Alert

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    Neurology Alert (Vol. 39, No. 1) - September 2019
    September 1, 2019

    Table Of Contents

    Antisense Oligonucleotide Treatment of Huntington’s Disease: A Novel Potential Treatment

    Calcitonin Gene-Related Peptide Targeting Therapies for Migraine

    Targeting Fyn Kinase in Alzheimer’s Disease: Another Failed Clinical Trial

    Risk of Neuropathy With Fluoroquinolones

    Racial and Ethnic Disparities in Thrombectomy in the United States

    After Ischemic Stroke Related to Atrial Fibrillation, Direct Oral Anticoagulants Are Superior to Vitamin K Antagonists

    Faster Time to Endovascular Reperfusion Therapy Results in Better Outcomes

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    Financial Disclosure: Neurology Alert’s Editor in Chief Matthew Fink, MD; Peer Reviewer M. Flint Beal, MD; Editorial Group Manager Leslie Coplin; Editor Jason Schneider; and Accreditations Manager Amy M. Johnson, MSN, RN, CPN, report no financial relationships relevant to this field of study.

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