1. Bourcier R, Goyal M, Liebeskind DS, et al. Association of Time From Stroke Onset to Groin Puncture With Quality of Reperfusion After Mechanical Thrombectomy. JAMA Neurol. 2019;76(4):405. doi:10.1001/jamaneurol.2018.4510.
Challenges in the field of acute ischemic stroke (AIS) related to large-vessel occlusion (LVO) focus on reducing time to reperfusion, optimizing imaging methods for patient selection, and evaluating the best technical approach. Reperfusion is significantly associated with clinical outcome in patients undergoing endovascular thrombectomy (EVT). Reperfusion is commonly scored with the modified TICI (mTICI) grading scale, with 0 indicating persistent complete occlusion and 3 indicating complete reperfusion. Because grade 2b was shown to be the best cutoff for predicting favorable outcome at 90 days, grades 2b and 3 are termed successful reperfusion. A pooled analysis of the first 5 randomized clinical stroke trials, which predominantly used stent retrievers as the primary approach, demonstrated that successful reperfusion was obtained in 71% of patients, whereas the rate of mTICI 0 to 2a varied from 12% to 41%. Successful reperfusion is influenced by device choice and strategy, use of intravenous (IV) alteplase, collateral status, and thrombus size, location, or composition.
The authors sought to analyze the rate of reperfusion after endovascular thrombectomy started at different intervals after symptom onset in patients with AIS. They conducted a meta-analysis of individual patient data from 7 randomized trials of the Highly Effective Reperfusion Using Multiple Endovascular Devices (HERMES) group. This is a multicenter cohort study of the intervention arm of randomized clinical trials included in the HERMES group. Patients with anterior circulation AIS who underwent endovascular thrombectomy for M1/M2 or intracranial carotid artery occlusion were included.
Among the 728 included patients decreases in rates of successful reperfusion defined as a TICI score of 2b/3 were observed with increasing time from admission or first imaging to groin puncture. …