RT Journal Article
SR Electronic
T1 Collateral status affects the onset-to-reperfusion time window for good outcome
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP jnnp-2017-317627
DO 10.1136/jnnp-2017-317627
A1 Byung Moon Kim
A1 Jang-Hyun Baek
A1 Ji Hoe Heo
A1 Hyo Suk Nam
A1 Young Dae Kim
A1 Joonsang Yoo
A1 Dong Joon Kim
A1 Pyoung Jeon
A1 Seung Kug Baik
A1 Sang Hyun Suh
A1 Kyung Yol Lee
A1 Hyo Sung Kwak
A1 Hong Gee Roh
A1 Young-Jun Lee
A1 Sang Heum Kim
A1 Chang-Woo Ryu
A1 Yon-Kwon Ihn
A1 Byungjoon Kim
A1 Hong Jun Jeon
A1 Jin Woo Kim
A1 Jun Soo Byun
A1 Sangil Suh
A1 Jeong Jin Park
A1 Woong Jae Lee
A1 Jieun Roh
A1 Byoung-Soo Shin
A1 Oh Young Bang
YR 2018
UL http://jnnp.bmj.com/content/early/2018/03/08/jnnp-2017-317627.abstract
AB Objective To characterise the time window in which endovascular thrombectomy (EVT) is associated with good outcome, and to test the differential relationship between functional outcome and onset-to-reperfusion time (ORT), depending on collateral status.Methods This was a retrospective analysis of clinical and imaging data of 554 consecutive patients, who had recanalisation success by EVT for anterior circulation large artery occlusion, from the prospectively maintained registries of 16 comprehensive stroke centres between September 2010 and December 2015. The patients were dichotomised into good and poor collateral groups, based on CT angiography. We tested whether the likelihood of good outcome (modified Rankin Scale, 0–2) by ORT was different between two groups.Results ORT was 298 min±113 min (range, 81–665 min), and 84.5% of patients had good collaterals. Age, diabetes mellitus, previous infarction, National Institutes of Health Stroke Scale, good collaterals (OR 40.766; 95% CI 10.668 to 155.78; p<0.001) and ORT (OR 0.926 every 30 min delay; 95% CI 0.862 to 0.995; p=0.037) were independently associated with good outcome. The drop in likelihood of good outcome associated with longer ORT was significantly faster in poor collateral group (OR 0.305 for every 30 min; 95% CI 0.113 to 0.822) than in good collateral group (OR 0.926 for every 30 min; 95% CI 0.875 to 0.980).Conclusions Earlier successful recanalisation was strongly associated with good outcome in poor collateral group; however, this association was weak during the tested time window in good collateral group. This suggests that the ORT window for good outcome can be adjusted according to collateral status.