Abstract Details

Title Endovascular Therapy Delay for Acute Large Vessel Occlusion (LVO) is Associated with Worse Functional Outcome and Increased Mortality - Quantified

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P13 - Poster Session 13 (8:00 AM-9:00 AM)

Poster/Presentation
Number 13-004

Background The importance of early MT has shown to improve functional outcomes for patients with acute LVO. As well, prior studies have shown that earlier MT resulted in reduced hospital stay, more home-time, and more desirable living situation in the 90 days after stroke.

Objective Demonstrate that delay in mechanical thrombectomy (MT) in patients with large vessel occlusion (LVO) would result in worse clinical outcome and increased mortality.

Design/Methods We performed a retrospective analysis of consecutive patients who underwent MT for LVO in a large academic comprehensive stroke center between 01/2018 and 05/2021. We compared outcomes including in-hospital mortality and 90-day modified Rankin Scale (mRS) based on time from door-to-puncture and door-to-reperfusion, adjusting for relevant covariates using logistic regression.

Results Patients that had shorter door-to-puncture time were found to have higher probability of a lower mRS (mRS 0-2) at discharge (p=0.03). Patients with door-to-puncture less than 60 minutes had a probability of 50% of achieving a good outcome. Longer door-to-puncture times were associated with lower probability of achieving mRS 0-2 at discharge. A similar finding was seen in patients that had shorter times to reperfusion (p=0.05). Adjusting for age, baseline NIHSS score, and final TICI score, delayed door-to-reperfusion time in minutes was an independent predictor of increased mortality at 90 days of 9% for every 10 minutes delay (OR 1.009, 95% CI 1.003-1.016, p=0.006). Every 10 minutes delay in door-to-reperfusion time had 7% higher chance of poor functional outcome at 90 days (OR 1.007, 95% CI 1.004-1.019, p=0.015).

Conclusions Shorter times to MT and reperfusion impact functional outcome and mortality in LVO stroke patients. This indicates that an adequate hospital protocol and continuous education may lead to faster and more efficient stroke activations leading to a shorter time to MT and eventual reperfusion. Goals of door-to-puncture must be established in order to achieve better outcomes.

Authors/Disclosures
Julian D. Carrion-Penagos, MD (University of Chicago) PRESENTER	Dr. Carrion-Penagos has nothing to disclose.
	No disclosure on file
Elisheva R. Coleman, MD (University of Chicago Medical Center)	Dr. Coleman has nothing to disclose.
James R. Brorson, MD (University of Chicago)	Dr. Brorson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for National Peer Review Corporation. Dr. Brorson has a non-compensated relationship as a Vascular Neurology Pilot Committee with American Board of Psychiatry and Neurology that is relevant to AAN interests or activities.
	No disclosure on file
Scott J. Mendelson, MD, PhD (Access TeleCare)	No disclosure on file
Shyam Prabhakaran, MD (University of Chicago)	Dr. Prabhakaran has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Cincinnati. Dr. Prabhakaran has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Cincinnati. The institution of Dr. Prabhakaran has received research support from NIH . The institution of Dr. Prabhakaran has received research support from AHRQ. Dr. Prabhakaran has received publishing royalties from a publication relating to health care.
Ali Mansour, MD (University of Chicago)	Dr. Mansour has nothing to disclose.
Tareq Kass-Hout, MD (Jackson Memorial Hospital)	No disclosure on file