The researchers posed the question: “What are the lifetime consequences associated with care process delays in patients with ischemic stroke who are treated with endovascular thrombectomy?” They searched PubMed for randomized clinical trials of stent retriever thrombectomy devices versus medical therapy in patients with anterior circulation LVO [large-vessel occlusion] within 12 hours of last known well time, and found seven for which a peer-reviewed, complete primary results article was published by August 1, 2020, and included all randomized clinical trials of stent retriever thrombectomy devices versus medical therapy in patients with anterior circulation LVO within 12 hours of last known well time.
Among the 781 EVT-treated patients, 52.0% were early-treated (last known well/onset-to-puncture time ≤4 hours) and 48.0% were late-treated (last known well/onset-to-puncture time >4-12 hours). In early-treated patients, last known well/onset-to-puncture time was 188 minutes and door-to-reperfusion time was 105 minutes. Among the 78.4% patients with substantial reperfusion, median door-to-reperfusion time was 145.0 minutes. Change in healthy life-years were measured as disability-adjusted life-years, which were calculated as the sum of years of life lost owing to premature mortality and years of healthy life lost because of disability.
The researchers wrote: ““That time delays in the LKW-to-door interval were not associated with benefit decline in late-treated patients and in early-treated patients accords with the clinical recognition that times of stroke onset elicited by history are imprecise even in early-arriving patients who have reduced representation of wake-up and unwitnessed-onset strokes. Conversely, that time delays in the door-to-intervention interval were associated with benefit decrease in early-treated patients and in late-treated patients indicates that when time measures are fully reliable, as is the case with ED arrival, a substantial benefit decrease will be associated with time passage even fairly late after stroke onset … Delays, particularly after arrival to the hospital until reperfusion is achieved, may result in substantial losses in years of healthy life for patients. Efforts to optimize workflow and eliminate barriers preventing timely patient evaluation and treatment within health care systems are warranted.”
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