Among patients with acute ischemic stroke, every 1 second delay in endovascular thrombectomy (EVT) treatment success is associated with a 2.4-hour loss of healthy life, according to a meta-analysis published in JAMA Neurology.

In this study, researchers included all data published before August of 2020 from the Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke (HERMES) collaboration. They assessed clinical outcomes on the basis of therapy. Late treatment was defined as greater than 4 to 12 hours from last known well time to arterial puncture (LKWTP). Any time of 4 hours or less from LKWTP was considered to be early treatment.

EVT was administered to 781 of the 871 patients. Most patients who did not receive a thrombectomy had reperfusion before EVT or tortuous vessels precluding navigation to the occlusion.


Continue Reading

Within the EVT cohort, 52.0% received early treatment and 48.0% received late treatment. The early and late groups comprised patients who had an average age of 66.2 (Standard Deviation [SD], ±13.4) and 64.7 (SD, ±13.5) years, 46.6% and 47.2% were women, and reperfusion was achieved among 78.4% and 68.4%, respectively.

Every 1-hour delay in last known well time to reperfusion was associated with a loss of 0.84 (95% CI, 0.28-1.39) healthy years among the early group and with 0.50 (95% CI, 0.07-0.92) healthy years among the late group. Every 1-hour delay in emergency department arrival to reperfusion was associated with a loss of 0.84 (95% CI, 0.26-1.42) healthy years in the early group and with 1.00 (95% CI, 0.60-1.41) healthy years in the late group.

Among the early group patients, a delay of 1 second in the door-to-puncture interval corresponded with 2.2 hours of healthy life lost, and a delay of 1 second in the door-to-reperfusion interval with 2.4 hours of healthy life lost.

This study was limited by the strict inclusion criteria of patients and may not be generalizable.

Findings indicated that timely reperfusion was a significant contributing factor to EVT outcomes among patients with acute ischemic stroke. Study researchers concluded, “Delays, particularly after arrival to the hospital until reperfusion is achieved, may result in substantial losses in years of healthy life for patients. Efforts to optimize workflow and eliminate barriers preventing timely patient evaluation and treatment within health care systems are warranted.”

Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.

Reference

Almekhlafi MA, Goyal M, Dippel DWJ, et al. Healthy Life-Year Costs of Treatment Speed From Arrival to Endovascular Thrombectomy in Patients With Ischemic Stroke A Meta-analysis of Individual Patient Data From 7 Randomized Clinical Trials. JAMA Neurol. 2021;78(6):709-717. doi:10.1001/jamaneurol.2021.1055