Do Physicians Intuitively Select Slow Progressors for Thrombectomy in the Extended Time Window?

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Salome L Bosshart - , University Hospital Zurich (Author)
  • Alexander Stebner - , Hospital Münsterlingen (Author)
  • Charlotte Zerna - , Municipal Hospital Dresden (Author)
  • Emma Harrison - , Princess Alexandra Hospital Brisbane (Author)
  • Timothy Kleinig - , Royal Adelaide Hospital (Author)
  • Volker Puetz - , Department of Neurology (Author)
  • Daniel P O Kaiser - , Institute and Polyclinic of Diagnostic and Interventional Neuroradiology (Author)
  • Brett Graham - , Saskatchewan Health Authority (Author)
  • Amy Y X Yu - , Sunnybrook Health Science Centre (Author)
  • Brian van Adel - , Hamilton Health Sciences, McMaster University (Author)
  • Jai Shankar - , University of Manitoba (Author)
  • Ryan McTaggart - , Brown University (Author)
  • Vitor Pereira - , Unity Health Toronto (Author)
  • Don F Frei - , Colorado Neurological Institute (Author)
  • Mayank Goyal - , University of Calgary (Author)
  • Michael D Hill - , University of Calgary (Author)
  • Johanna M Ospel - , University of Calgary (Author)

Abstract

Background: In acute ischemic stroke, a longer time from onset to endovascular treatment (EVT) is associated with worse clinical outcome. We investigated the association of clinical outcome with time from last known well to arrival at the EVT hospital and time from hospital arrival to arterial access for anterior circulation large vessel occlusion patients treated > 6 hours from last known well. Methods: Retrospective analysis of the prospective, multicenter cohort study ESCAPE-LATE. Patients presenting > 6 hours after last known well with anterior circulation large vessel occlusion undergoing EVT were included. The primary outcome was the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes were good (mRS 0-2) and poor clinical outcomes (mRS 5-6) at 90 days, as well as the National Institutes of Health Stroke Scale at 24 hours. Associations of time intervals with outcomes were assessed with univariable and multivariable logistic regression. Results: Two hundred patients were included in the analysis, of whom 85 (43%) were female. 90-day mRS was available for 141 patients. Of the 150 patients, 135 (90%) had moderate-to-good collaterals, and the median Alberta Stroke Program Early CT Score (ASPECTS) was 8 (IQR = 7-10). No association between ordinal mRS and time from last known well to arrival at the EVT hospital (odds ratio [OR] = 1.01, 95% CI = 1.00-1.02) or time from hospital arrival to arterial access (OR = -0.01, 95% CI = -0.02-0.00) was seen in adjusted regression models. Conclusion: No relationship was observed between pre-hospital or in-hospital workflow times and clinical outcomes. Baseline ASPECTS and collateral status were favorable in the majority of patients, suggesting that physicians may have chosen to predominantly treat slow progressors in the late time window, in whom prolonged workflow times have less impact on outcomes.

Details

Original languageEnglish
Pages (from-to)982-988
Number of pages7
JournalThe Canadian journal of neurological sciences = Le journal canadien des sciences neurologiques
Volume52
Issue number6
Early online date12 Mar 2025
Publication statusPublished - 1 Nov 2025
Peer-reviewedYes

External IDs

Scopus 105000411381
ORCID /0000-0001-5258-0025/work/181860906

Keywords

ASJC Scopus subject areas

Keywords

  • imaging, patient selection, slow progressors, stroke, thrombectomy