Association of Time from Stroke Onset to Groin Puncture with Quality of Reperfusion after Mechanical Thrombectomy: A Meta-analysis of Individual Patient Data from 7 Randomized Clinical Trials

Romain Bourcier, Mayank Goyal, David S. Liebeskind, Keith W. Muir, Hubert Desal, Adnan H. Siddiqui, Diederik W.J. Dippel, Charles B. Majoie, Wim H. Van Zwam, Tudor G. Jovin, Elad I. Levy, Peter J. Mitchell, Olvert A. Berkhemer, Stephen M. Davis, Imad Derraz, Geoffrey A. Donnan, Andrew M. Demchuk, Robert J. Van Oostenbrugge, Michael Kelly, Yvo B. Roos & 23 others Reza Jahan, Aad Van Der Lugt, Marieke Sprengers, Stephane Velasco, Geert J. Lycklama À Nijeholt, Wagih Ben Hassen, Paul Burns, Scott Brown, Emmanuel Chabert, Timo Krings, Hana Chloe, Christian Weimar, Bruce C.V. Campbell, Gary A. Ford, Marc Ribo, Phil White, Geoffrey C. Cloud, Luis San Roman, Antoni Davalos, Olivier Naggara, Michael D. Hill, Serge Bracard, for the HERMES Trialists Collaboration

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Importance: Reperfusion is a key factor for clinical outcome in patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT) for large-vessel intracranial occlusion. However, data are scarce on the association between the time from onset and reperfusion results. Objective: To analyze the rate of reperfusion after EVT started at different intervals after symptom onset in patients with AIS. Design, Setting, and Participants: We conducted a meta-analysis of individual patient data from 7 randomized trials of the Highly Effective Reperfusion Using Multiple Endovascular Devices (HERMES) group. This is a multicenter cohort study of the intervention arm of randomized clinical trials included in the HERMES group. Patients with anterior circulation AIS who underwent EVT for M1/M2 or intracranial carotid artery occlusion were included. Each trial enrolled patients according to its specific inclusion and exclusion criteria. Data on patients eligible but not enrolled (eg, refusals or exclusions) were not available. All analyses were performed by the HERMES biostatistical core laboratory using the pooled database. Data were analyzed between December 2010 and April 2015. Main Outcomes and Measures: Successful reperfusion was defined as a modified thrombolysis in cerebral infarction score of 2b/3 at the end of the EVT procedure adjusted for age, occlusion location, pretreatment intravenous thrombolysis, and clot burden score and was analyzed in relation to different intervals (onset, emergency department arrival, imaging, and puncture) using mixed-methods logistic regression. Results: Among the 728 included patients, with a mean (SD) age of 65.4 (13.5) years and of whom 345 were female (47.4%), decreases in rates of successful reperfusion defined as a thrombolysis in cerebral infarction score of 2b/3 were observed with increasing time from admission or first imaging to groin puncture. The magnitude of effect was a 22% relative reduction (odds ratio, 0.78; 95% CI, 0.64-0.95) per additional hour between admission and puncture and a 26% relative reduction (odds ratio, 0.74; 95% CI, 0.59-0.93) per additional hour between imaging and puncture. Conclusions and Relevance: Because the probability of reperfusion declined significantly with time between hospital arrival and groin puncture, we provide additional arguments for minimizing the intervals after symptom onset in anterior circulation acute ischemic stroke..

Original languageEnglish
Pages (from-to)405-411
Number of pages7
JournalJAMA Neurology
Volume76
Issue number4
DOIs
Publication statusPublished - Apr 2019

Cite this

Bourcier, Romain ; Goyal, Mayank ; Liebeskind, David S. ; Muir, Keith W. ; Desal, Hubert ; Siddiqui, Adnan H. ; Dippel, Diederik W.J. ; Majoie, Charles B. ; Van Zwam, Wim H. ; Jovin, Tudor G. ; Levy, Elad I. ; Mitchell, Peter J. ; Berkhemer, Olvert A. ; Davis, Stephen M. ; Derraz, Imad ; Donnan, Geoffrey A. ; Demchuk, Andrew M. ; Van Oostenbrugge, Robert J. ; Kelly, Michael ; Roos, Yvo B. ; Jahan, Reza ; Van Der Lugt, Aad ; Sprengers, Marieke ; Velasco, Stephane ; Lycklama À Nijeholt, Geert J. ; Ben Hassen, Wagih ; Burns, Paul ; Brown, Scott ; Chabert, Emmanuel ; Krings, Timo ; Chloe, Hana ; Weimar, Christian ; Campbell, Bruce C.V. ; Ford, Gary A. ; Ribo, Marc ; White, Phil ; Cloud, Geoffrey C. ; San Roman, Luis ; Davalos, Antoni ; Naggara, Olivier ; Hill, Michael D. ; Bracard, Serge ; for the HERMES Trialists Collaboration. / Association of Time from Stroke Onset to Groin Puncture with Quality of Reperfusion after Mechanical Thrombectomy : A Meta-analysis of Individual Patient Data from 7 Randomized Clinical Trials. In: JAMA Neurology. 2019 ; Vol. 76, No. 4. pp. 405-411.
@article{c61c967549ce47d48064a2723b604643,
title = "Association of Time from Stroke Onset to Groin Puncture with Quality of Reperfusion after Mechanical Thrombectomy: A Meta-analysis of Individual Patient Data from 7 Randomized Clinical Trials",
abstract = "Importance: Reperfusion is a key factor for clinical outcome in patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT) for large-vessel intracranial occlusion. However, data are scarce on the association between the time from onset and reperfusion results. Objective: To analyze the rate of reperfusion after EVT started at different intervals after symptom onset in patients with AIS. Design, Setting, and Participants: We conducted a meta-analysis of individual patient data from 7 randomized trials of the Highly Effective Reperfusion Using Multiple Endovascular Devices (HERMES) group. This is a multicenter cohort study of the intervention arm of randomized clinical trials included in the HERMES group. Patients with anterior circulation AIS who underwent EVT for M1/M2 or intracranial carotid artery occlusion were included. Each trial enrolled patients according to its specific inclusion and exclusion criteria. Data on patients eligible but not enrolled (eg, refusals or exclusions) were not available. All analyses were performed by the HERMES biostatistical core laboratory using the pooled database. Data were analyzed between December 2010 and April 2015. Main Outcomes and Measures: Successful reperfusion was defined as a modified thrombolysis in cerebral infarction score of 2b/3 at the end of the EVT procedure adjusted for age, occlusion location, pretreatment intravenous thrombolysis, and clot burden score and was analyzed in relation to different intervals (onset, emergency department arrival, imaging, and puncture) using mixed-methods logistic regression. Results: Among the 728 included patients, with a mean (SD) age of 65.4 (13.5) years and of whom 345 were female (47.4{\%}), decreases in rates of successful reperfusion defined as a thrombolysis in cerebral infarction score of 2b/3 were observed with increasing time from admission or first imaging to groin puncture. The magnitude of effect was a 22{\%} relative reduction (odds ratio, 0.78; 95{\%} CI, 0.64-0.95) per additional hour between admission and puncture and a 26{\%} relative reduction (odds ratio, 0.74; 95{\%} CI, 0.59-0.93) per additional hour between imaging and puncture. Conclusions and Relevance: Because the probability of reperfusion declined significantly with time between hospital arrival and groin puncture, we provide additional arguments for minimizing the intervals after symptom onset in anterior circulation acute ischemic stroke..",
author = "Romain Bourcier and Mayank Goyal and Liebeskind, {David S.} and Muir, {Keith W.} and Hubert Desal and Siddiqui, {Adnan H.} and Dippel, {Diederik W.J.} and Majoie, {Charles B.} and {Van Zwam}, {Wim H.} and Jovin, {Tudor G.} and Levy, {Elad I.} and Mitchell, {Peter J.} and Berkhemer, {Olvert A.} and Davis, {Stephen M.} and Imad Derraz and Donnan, {Geoffrey A.} and Demchuk, {Andrew M.} and {Van Oostenbrugge}, {Robert J.} and Michael Kelly and Roos, {Yvo B.} and Reza Jahan and {Van Der Lugt}, Aad and Marieke Sprengers and Stephane Velasco and {Lycklama {\`A} Nijeholt}, {Geert J.} and {Ben Hassen}, Wagih and Paul Burns and Scott Brown and Emmanuel Chabert and Timo Krings and Hana Chloe and Christian Weimar and Campbell, {Bruce C.V.} and Ford, {Gary A.} and Marc Ribo and Phil White and Cloud, {Geoffrey C.} and {San Roman}, Luis and Antoni Davalos and Olivier Naggara and Hill, {Michael D.} and Serge Bracard and {for the HERMES Trialists Collaboration}",
year = "2019",
month = "4",
doi = "10.1001/jamaneurol.2018.4510",
language = "English",
volume = "76",
pages = "405--411",
journal = "JAMA Neurology",
issn = "2168-6149",
publisher = "American Medical Association (AMA)",
number = "4",

}

Bourcier, R, Goyal, M, Liebeskind, DS, Muir, KW, Desal, H, Siddiqui, AH, Dippel, DWJ, Majoie, CB, Van Zwam, WH, Jovin, TG, Levy, EI, Mitchell, PJ, Berkhemer, OA, Davis, SM, Derraz, I, Donnan, GA, Demchuk, AM, Van Oostenbrugge, RJ, Kelly, M, Roos, YB, Jahan, R, Van Der Lugt, A, Sprengers, M, Velasco, S, Lycklama À Nijeholt, GJ, Ben Hassen, W, Burns, P, Brown, S, Chabert, E, Krings, T, Chloe, H, Weimar, C, Campbell, BCV, Ford, GA, Ribo, M, White, P, Cloud, GC, San Roman, L, Davalos, A, Naggara, O, Hill, MD, Bracard, S & for the HERMES Trialists Collaboration 2019, 'Association of Time from Stroke Onset to Groin Puncture with Quality of Reperfusion after Mechanical Thrombectomy: A Meta-analysis of Individual Patient Data from 7 Randomized Clinical Trials' JAMA Neurology, vol. 76, no. 4, pp. 405-411. https://doi.org/10.1001/jamaneurol.2018.4510

Association of Time from Stroke Onset to Groin Puncture with Quality of Reperfusion after Mechanical Thrombectomy : A Meta-analysis of Individual Patient Data from 7 Randomized Clinical Trials. / Bourcier, Romain; Goyal, Mayank; Liebeskind, David S.; Muir, Keith W.; Desal, Hubert; Siddiqui, Adnan H.; Dippel, Diederik W.J.; Majoie, Charles B.; Van Zwam, Wim H.; Jovin, Tudor G.; Levy, Elad I.; Mitchell, Peter J.; Berkhemer, Olvert A.; Davis, Stephen M.; Derraz, Imad; Donnan, Geoffrey A.; Demchuk, Andrew M.; Van Oostenbrugge, Robert J.; Kelly, Michael; Roos, Yvo B.; Jahan, Reza; Van Der Lugt, Aad; Sprengers, Marieke; Velasco, Stephane; Lycklama À Nijeholt, Geert J.; Ben Hassen, Wagih; Burns, Paul; Brown, Scott; Chabert, Emmanuel; Krings, Timo; Chloe, Hana; Weimar, Christian; Campbell, Bruce C.V.; Ford, Gary A.; Ribo, Marc; White, Phil; Cloud, Geoffrey C.; San Roman, Luis; Davalos, Antoni; Naggara, Olivier; Hill, Michael D.; Bracard, Serge; for the HERMES Trialists Collaboration.

In: JAMA Neurology, Vol. 76, No. 4, 04.2019, p. 405-411.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Association of Time from Stroke Onset to Groin Puncture with Quality of Reperfusion after Mechanical Thrombectomy

T2 - A Meta-analysis of Individual Patient Data from 7 Randomized Clinical Trials

AU - Bourcier, Romain

AU - Goyal, Mayank

AU - Liebeskind, David S.

AU - Muir, Keith W.

AU - Desal, Hubert

AU - Siddiqui, Adnan H.

AU - Dippel, Diederik W.J.

AU - Majoie, Charles B.

AU - Van Zwam, Wim H.

AU - Jovin, Tudor G.

AU - Levy, Elad I.

AU - Mitchell, Peter J.

AU - Berkhemer, Olvert A.

AU - Davis, Stephen M.

AU - Derraz, Imad

AU - Donnan, Geoffrey A.

AU - Demchuk, Andrew M.

AU - Van Oostenbrugge, Robert J.

AU - Kelly, Michael

AU - Roos, Yvo B.

AU - Jahan, Reza

AU - Van Der Lugt, Aad

AU - Sprengers, Marieke

AU - Velasco, Stephane

AU - Lycklama À Nijeholt, Geert J.

AU - Ben Hassen, Wagih

AU - Burns, Paul

AU - Brown, Scott

AU - Chabert, Emmanuel

AU - Krings, Timo

AU - Chloe, Hana

AU - Weimar, Christian

AU - Campbell, Bruce C.V.

AU - Ford, Gary A.

AU - Ribo, Marc

AU - White, Phil

AU - Cloud, Geoffrey C.

AU - San Roman, Luis

AU - Davalos, Antoni

AU - Naggara, Olivier

AU - Hill, Michael D.

AU - Bracard, Serge

AU - for the HERMES Trialists Collaboration

PY - 2019/4

Y1 - 2019/4

N2 - Importance: Reperfusion is a key factor for clinical outcome in patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT) for large-vessel intracranial occlusion. However, data are scarce on the association between the time from onset and reperfusion results. Objective: To analyze the rate of reperfusion after EVT started at different intervals after symptom onset in patients with AIS. Design, Setting, and Participants: We conducted a meta-analysis of individual patient data from 7 randomized trials of the Highly Effective Reperfusion Using Multiple Endovascular Devices (HERMES) group. This is a multicenter cohort study of the intervention arm of randomized clinical trials included in the HERMES group. Patients with anterior circulation AIS who underwent EVT for M1/M2 or intracranial carotid artery occlusion were included. Each trial enrolled patients according to its specific inclusion and exclusion criteria. Data on patients eligible but not enrolled (eg, refusals or exclusions) were not available. All analyses were performed by the HERMES biostatistical core laboratory using the pooled database. Data were analyzed between December 2010 and April 2015. Main Outcomes and Measures: Successful reperfusion was defined as a modified thrombolysis in cerebral infarction score of 2b/3 at the end of the EVT procedure adjusted for age, occlusion location, pretreatment intravenous thrombolysis, and clot burden score and was analyzed in relation to different intervals (onset, emergency department arrival, imaging, and puncture) using mixed-methods logistic regression. Results: Among the 728 included patients, with a mean (SD) age of 65.4 (13.5) years and of whom 345 were female (47.4%), decreases in rates of successful reperfusion defined as a thrombolysis in cerebral infarction score of 2b/3 were observed with increasing time from admission or first imaging to groin puncture. The magnitude of effect was a 22% relative reduction (odds ratio, 0.78; 95% CI, 0.64-0.95) per additional hour between admission and puncture and a 26% relative reduction (odds ratio, 0.74; 95% CI, 0.59-0.93) per additional hour between imaging and puncture. Conclusions and Relevance: Because the probability of reperfusion declined significantly with time between hospital arrival and groin puncture, we provide additional arguments for minimizing the intervals after symptom onset in anterior circulation acute ischemic stroke..

AB - Importance: Reperfusion is a key factor for clinical outcome in patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT) for large-vessel intracranial occlusion. However, data are scarce on the association between the time from onset and reperfusion results. Objective: To analyze the rate of reperfusion after EVT started at different intervals after symptom onset in patients with AIS. Design, Setting, and Participants: We conducted a meta-analysis of individual patient data from 7 randomized trials of the Highly Effective Reperfusion Using Multiple Endovascular Devices (HERMES) group. This is a multicenter cohort study of the intervention arm of randomized clinical trials included in the HERMES group. Patients with anterior circulation AIS who underwent EVT for M1/M2 or intracranial carotid artery occlusion were included. Each trial enrolled patients according to its specific inclusion and exclusion criteria. Data on patients eligible but not enrolled (eg, refusals or exclusions) were not available. All analyses were performed by the HERMES biostatistical core laboratory using the pooled database. Data were analyzed between December 2010 and April 2015. Main Outcomes and Measures: Successful reperfusion was defined as a modified thrombolysis in cerebral infarction score of 2b/3 at the end of the EVT procedure adjusted for age, occlusion location, pretreatment intravenous thrombolysis, and clot burden score and was analyzed in relation to different intervals (onset, emergency department arrival, imaging, and puncture) using mixed-methods logistic regression. Results: Among the 728 included patients, with a mean (SD) age of 65.4 (13.5) years and of whom 345 were female (47.4%), decreases in rates of successful reperfusion defined as a thrombolysis in cerebral infarction score of 2b/3 were observed with increasing time from admission or first imaging to groin puncture. The magnitude of effect was a 22% relative reduction (odds ratio, 0.78; 95% CI, 0.64-0.95) per additional hour between admission and puncture and a 26% relative reduction (odds ratio, 0.74; 95% CI, 0.59-0.93) per additional hour between imaging and puncture. Conclusions and Relevance: Because the probability of reperfusion declined significantly with time between hospital arrival and groin puncture, we provide additional arguments for minimizing the intervals after symptom onset in anterior circulation acute ischemic stroke..

UR - http://www.scopus.com/inward/record.url?scp=85060215940&partnerID=8YFLogxK

U2 - 10.1001/jamaneurol.2018.4510

DO - 10.1001/jamaneurol.2018.4510

M3 - Article

VL - 76

SP - 405

EP - 411

JO - JAMA Neurology

JF - JAMA Neurology

SN - 2168-6149

IS - 4

ER -