Procedure Time of Endovascular Thrombectomy as Performance Measure of Acute Stroke Treatment

• Published in: Neurointervention Vol. 20; no. 2; pp. 71 - 81
• Main Authors: Lee, Eung-Joon, Jeong, Han-Yeong, Kim, Jayoun, Park, Nan Hee, Kang, Min Kyoung, Lee, Dongwhane, Kim, Jinkwon, Jung, Yo Han, Yu, Sungwook, Kim, Wook-Joo, Cho, Han-Jin, Lee, Kyungbok, Park, Tai Hwan, Oh, Mi Sun, Lee, Ji Sung, Kim, Joon-Tae, Yoon, Byung-Woo, Park, Jong-Moo, Bae, Hee-Joon, Jung, Keun-Hwa
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Society of Interventional Neuroradiology 01.07.2025; 대한신경중재치료의학회
• Subjects: ischemic stroke; operative time; Original Paper; registries; thrombectomy; 방사선과학; Registries; Thrombectomy; Operative time; Ischemic stroke
• ISSN: 2093-9043; 2233-6273
• DOI: 10.5469/neuroint.2025.00178

Purpose: Procedure time (PT), defined as the time between groin access and vessel recanalization, is a recently recognized predictor of outcomes after endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). However, the factors affecting PT and its potential value as a performance measure of AIS treatment remain unexplored.Materials and Methods: Using the Korean Stroke Registry, we compared patients who underwent EVT for AIS from 2018 to 2022 based on 60 minutes PT. We conducted multivariate analysis to investigate whether PT <60 minutes was associated with successful recanalization and good functional stroke outcomes. We also investigated factors that independently predicted PT ≥60 minutes. Furthermore, we determined the cutoff point for PT.Results: We analyzed 4,703 patients (mean age: 69.5±11.9, 60.3% male) who underwent EVT. The mean PT was 54.6±36.7 minutes. Multivariate analysis revealed that PT <60 minutes independently predicted a good functional outcome as represented by modified Rankin Scale scores of 0–2 (adjusted odds ratio [aOR]: 1.40, 95% confidence interval [CI]: 1.22–1.59). PT <60 minutes was significantly associated with successful recanalization after adjusting for confounding variables (aOR: 1.66, 95% CI: 1.33–2.07). Moreover, after adjusting for covariates, age≥65 years (aOR: 1.20, 95% CI: 1.05–1.38), onset-to-door time (aOR: 1.03, 95% CI: 1.01–1.04), door-to-puncture time (aOR: 1.05, 95% CI: 1.03–1.06), posterior circulation stroke (PCS) (aOR: 1.13, 95% CI: 1.02–1.28), and smoking (aOR: 1.24, 95%CI: 1.09–1.45) independently predicted PT ≥60 minutes. Finally, the highest aOR for good stroke outcome was observed in the 60-minute cutoff model (aOR: 1.45, 95%CI: 1.27–1.67).Conclusion: PT <60 minutes was significantly associated with good functional outcomes. Conversely, PT ≥60 minutes was associated with older age, PCS, smoking, prolonged onset-to-door and door-to-puncture time. Further studies are necessary to develop refining strategies for optimizing PT to improve stroke outcomes.