Abstract W P23: Predictors of Time From Groin Puncture to Base Catheter Placement

Abstract

Background and Purpose: Time to reperfusion is recognized as an important predictor of good outcome in endovascular stroke therapy. A significant but unstudied factor in delay to reperfusion is prolonged time from groin puncture to base catheter placement (P2C). The purpose of this study was to assess the factors that influence time from P2C in the cohort of patients in whom procedural steps were collected prospectively. Methods: A prospective analysis of patients who had intra-arterial therapy for acute stroke from August of 2012 to August of 2013 was performed. Following characteristics were collected: baseline clinical demographics, aortic arch types, time from P2C, procedural and clinical outcomes. Results: Data from a total of 143 patients were collected prospectively {median age 69 years; median baseline NIH Stroke Scale 16; occlusion sites: MCA-M1 71%; MCA-M2 13%, ICA-T 6%, basilar artery 10%, tandem occlusion 26%}. Patients were further divided based on their arch type (type 1: 48%, type 2: 33%, type 3: 13%). Majority of the patients were treated with newer mechanical embolectomy devices (manual aspiration +/- stent-retriever 96%). Recanalization rate (TICI 2b or 3) was 90%. The median procedural times were as follow (minutes): time from P2C: 20, time from baseline catheter to reperfusion: 36, median total procedural times: 85. The rate of favorable functional outcomes at 90 days (mRS 0-2) was 45%. Patients with favorable outcomes had shorter P2C (31 min vs. 19 min p=0.02). In a multivariate analysis the predictors of longer P2C were age (OR 1.04, P=0.05, 95% CI 1.00-1.08), vertebrobasilar location (OR 5.4, P=0.027, 95% CI 1.21-24.1), smoking (OR 3.7, P=0.02, 95% 1.2-11.1), and with trend toward significance for hypertension (OR 3.03, P=0.062, 95% 0.94-0.97). Discussion: Shorter P2C is associated with higher rate of favorable outcomes. Independent risk factors associated longer time are age, vertebrobasilar occlusions, active smoking and history of hypertension. Alternative arterial access may be considered in patients who are likely to have longer P2C.