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Tytuł pozycji:

Effect of time from onset to endovascular therapy on outcomes: the National Acute Stroke Israeli (NASIS)-REVASC registry.

Tytuł:
Effect of time from onset to endovascular therapy on outcomes: the National Acute Stroke Israeli (NASIS)-REVASC registry.
Autorzy:
Peretz S; Department of Neurology, Rabin Medical Center, Petah Tikva, Israel.
Raphaeli G; Neurology and Interventional Neuroradiology Unit, Rabin Medical Center, Petach Tikva, Israel.
Borenstein N; Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Leker RR; Department of Neurology, Hadassah-Hebrew Univ Med Ctr, Jerusalem, Israel.
Brauner R; Department of Neurology, Rabin Medical Center, Petah Tikva, Israel.
Horev A; Department of Neurology, Soroka University Medical Center, Beer Sheva, Southern, Israel.
Cohen JE; Neurosurgery and Radiology, Hadassah-Hebrew Univ Med Ctr, Jerusalem, Israel.
Telman G; Department of Neurology, Rambam Health Care Campus, Haifa, Haifa, Israel.
Halevi H; Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Tanne D; Department of Neurology, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel.
Źródło:
Journal of neurointerventional surgery [J Neurointerv Surg] 2020 Jan; Vol. 12 (1), pp. 13-18. Date of Electronic Publication: 2019 Jun 25.
Typ publikacji:
Journal Article
Język:
English
Imprint Name(s):
Original Publication: London : BMJ Publishing Group, c2009-
MeSH Terms:
Registries*
Time-to-Treatment*/trends
Brain Ischemia/*surgery
Endovascular Procedures/*methods
Stroke/*surgery
Aged ; Aged, 80 and over ; Brain Ischemia/diagnostic imaging ; Endovascular Procedures/trends ; Female ; Humans ; Israel/epidemiology ; Middle Aged ; Patient Transfer/methods ; Patient Transfer/trends ; Reperfusion/methods ; Reperfusion/trends ; Stroke/diagnostic imaging ; Treatment Outcome
Contributed Indexing:
Keywords: endovascular therapy; interhospital transfer; national stroke registry; onset-to-puncture time; real-world data
Entry Date(s):
Date Created: 20190627 Date Completed: 20200317 Latest Revision: 20200317
Update Code:
20240104
DOI:
10.1136/neurintsurg-2019-014928
PMID:
31239333
Czasopismo naukowe
Background: Endovascular therapy (EVT) is currently the most effective treatment for emergent large vessel occlusion (ELVO) stroke. Earlier treatment is associated with a better clinical outcome. Our aim was to examine the association between onset-to-EVT (OTE) time and clinical outcomes using real-world nationwide data from the National Acute Stroke ISraeli (NASIS)-REVASC registry.
Methods: Stroke patients undergoing EVT within the Endovascular Capable Centres (ECCs) in Israel between January 2014 and March 2016 were prospectively included. Several clinical and radiological outcomes were evaluated. The association between OTE time and outcomes was analyzed with logistic regression models using time as a continuous variable and then by OTE groups of <2, 2-4, 4-6, and >6 hours.
Results: 299 patients with acute stroke were included in the analysis. OTE time was significantly associated with favorable outcomes. ORs for each hour of delay in EVT were 0.84 (95% CI 0.71 to 0.99) for significant early recovery, 0.80 (95% CI 0.68 to 0.94) for discharge to home, 0.80 (95% CI 0.66 to 0.95) for freedom from disability at discharge, and 0.78 (95% CI 0.67 to 0.91) for excellent reperfusion (Thrombolysis in Cerebral Ischemia 3). The <2 OTE group was significantly associated with better outcomes than the ≥2 OTE group including significant early recovery (OR 3.3, 95% CI 1.2 to 9.1), discharge to home (OR 3.32, 95% CI 1.3 to 8.5), and excellent reperfusion (OR 4.6, 95% CI 1.3 to 29.5). The same trend was observed for freedom from disability at discharge and 3 months (OR 2.08, 95% CI 0.7 to 5.7 and OR 2.57, 95% CI 0.8 to 8.3, respectively). Only 1% of transferred patients achieved an OTE time of <2 hours.
Conclusions: Nationwide real-life registry data indicate that benefit from EVT is strongly associated with OTE time and is most prominent within the 'two golden hours' from stroke onset. This time goal may not be applicable in inter-hospital transfer patients.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

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