E-147 time to presentation is a good predictor in the delay to mechanical thrombectomy in acute ischemic stroke

Abstract

Purpose The importance of early reperfusion to functional recovery after mechanical thrombectomy is well established. Factors contributing to the delay of endovascular therapies remain unclear. Data was analyzed to evaluate the cause (s) for delaying the start of IA intervention in the Penumbra trials. Methods A pooled analysis of 1028 patients was conducted from the prospective and retrospective Penumbra trials (Pivotal N = 124, PICS N = 261, START N = 133, POST N = 108, RetroSTART N = 191, Speed 054 N = 71). All obtained treatment at The univariate relationships between the outcomes and predictor variables were calculated using Spearman’s rank correlation for continuous variables and Wilcoxon rank sums for two-group variables. Predictors of hours from arrival to procedure start with a univariate significance of p Results Among the 1028 patients pooled, 742 met study criteria. Mean age was 66 ± 15 and 53% were female. The median admission NIHSS score was 18 (IQR 13–21) and 49% were administered IV-tPA prior to mechanical thrombectomy. Baseline ASPECTS of 0–4, 5–7, 8–10 was 9.5%, 34.5% and 56%, respectively. The median time from symptom onset to hospital arrival was 128 (IQR 63–210) minutes. The median time from hospital arrival to procedure start was 121 (79–165) minutes. In the univariate analysis, age, gender, target vessel location, baseline NIHSS, IV-tPA prior to IAT, and general anesthesia were not associated with longer arrival to puncture times. The strongest predictors of arrival time to puncture were transfer patient status (p Conclusion In this pooled analysis, transferred patients had a lower door to puncture time, but overall greater total time from onset to puncture longer than direct admit. Even with direct admission patients, as onset to arrival time increased, door to puncture times decreased. Our findings suggest that there is a need to conduct an intensive review of in-hospital triaging procedures for endovascular therapy. Disclosures A. Yoo: 2; C; NIH, Penumbra, Inc., Remedy Pharmaceuticals. R. Gupta: None. B. Mehta: None. H. Buell: 5; C; Penumbra, Inc. K. Adamski: 5; C; Penumbra, Inc. S. Hak: 5; C; Penumbra, Inc. S. Kuo: 5; C; Penumbra, Inc. A. Bose: 4; C; Penumbra, Inc. 5; C; Penumbra, Inc. S. Sit: 4; C; Penumbra, Inc. 5; C; Penumbra, Inc.