Effect of needle-to-puncture time on reperfusion outcome in acute ischemic stroke

Introduction To investigate the impact of time interval between start of intravenous thrombolysis (IVT) to start of endovascular thrombectomy (EVT) on stroke outcomes. Methods Data from the Quality Improvement and Clinical Research (QuICR) provincial stroke registry from Alberta, Canada was used to identify stroke patients who received IVT and EVT from January 2015 to December 2019. We assessed the impact of the time interval between IVT bolus to EVT puncture (needle-to-puncture times "NPT") on outcomes. Radiological outcomes included successful initial recanalization (revised arterial occlusive lesion 2b-3), successful initial and final reperfusion (modified thrombolysis in cerebral infarction 2b-3). Clinical outcomes were 90-day modified Rankin Scale (mRS) and mortality.Results Of the 680 patients, 233 patients (median age 73, 41% females) received IVT+EVT. Median NPT was 38 minutes (IQR, 24-60). Arrival during working hours was independently associated with shorter NPT (P < 0.001). Successful initial recanalization, initial and final reperfusion were observed in 12%, 10% and 83% of patients, respectively. NPT was not associated with initial successful recanalization (OR 0.97 for every 10-minute increase of NPT, 95% CI 0.91 - 1.04), initial successful reperfusion (OR 1.01, 95% CI 0.96 - 1.07), or final successful reperfusion (OR 1.03, 95% CI 0.97 - 1.08). Every 10-minute delay in NPT was associated with lower odds of functional independence at 90 days (mRS & LE; 2; OR 0.93; 95% CI, 0.88-0.97). Patients with shorter NPT (& LE; 38 min) had lower 90-day mRS scores (median 1 vs 3; OR 0.54 [0.31-0.91]) and had lower mortality (6.1% vs 21.2%; OR, 0.23 [0.10-0.57]) than the longer NPT group.Conclusion Shorter NPT did not impact reperfusion outcomes, but was associated with better clinical outcome.