The association between time to endovascular treatment and functional outcome in patients with acute ischemic stroke may be stronger than previously suggested, according to the results of the MR CLEAN registry.
The registry aims to assess the link between time to endovascular treatment and functional outcome in everyday clinical practice. Many randomized clinical trials of patients with acute ischemic stroke have had strict inclusion and exclusion criteria that may have limited the applicability of the results to real-life situations.
The registry includes all centers that perform endovascular therapy in the Netherlands, and it is an ongoing prospective, observational study. The current results involve 1,488 patients who received treatment between March 2014 and June 2016, with the primary analysis evaluating the association of time from stroke onset to start of endovascular therapy and time from stroke onset to successful reperfusion with functional outcome.
The results of the current analysis revealed that greater time to commencing endovascular therapy was linked with worse functional outcome and a 2.2% increase in mortality. With every additional hour that passed from the onset of stroke to the start of endovascular treatment, there was a 5.3% decreased probability of functional independence, the researchers noted. Additionally, among the 742 patients in the study who had successful reperfusion, there was a 7.7% decreased probability of functional independence for every hour increase from stroke onset to reperfusion.
“Time to endovascular therapy for acute ischemic stroke in current clinical practice is strongly associated with functional outcome. Our data suggest that this association might be even stronger than previously suggested in reports on more selected patient populations from randomized controlled trials,” the researchers concluded. They added, “These findings emphasize that functional outcome of endovascular therapy patients can be greatly improved by shortening onset to treatment times.”
Mulder MJHL, Jansen IGH, Goldhoorn RB, et al. Time to endovascular treatment and outcome in acute ischemic stroke: MR CLEAN registry results. Circulation. 2018 Mar 26. pii: CIRCULATIONAHA.117.032600.