Introduction: Endovascular thrombectomy for acute ischemic stroke (AIS) is time sensitive and faster intervention can lead to better patient outcomes. Quality improvement (QI) measures typically focus on door to needle and groin puncture times. Increased fluoroscopy time (FT) has been associated with increased cerebral angiography complication rates. We aimed to understand the predictors of lower FT and its effect on 3-month clinical outcomes.
Methods: We performed a retrospective study of AIS patients with large vessel occlusion who underwent mechanical thrombectomy at our center from 2008 to 2014. We performed univariate analysis between FT (dichotomized in ≤ 50 minutes (lower) and >50 minutes (higher) based on the 75th percentile) and patients demographics, stroke severity, procedural data and outcomes measured including TICI recanalization scores and 90-day modified Rankin Scale (mRS). Significant predictors (p<0.05) from univariate analysis were entered into a multivariate logistic regression model to identify independent predictors.
Results: Out of 98 patients, 77 (79%) patients had FT ≤50 minutes. Significant predictors of lower FT were men (56% vs 44%, p=0.01), no congestive heart failure (87%% vs 13%. P=0.0005), no atrial fibrillation (74% vs 26%, p=0.01), no ICA occlusion (83% vs 17%, p=0.01), and non-aspiration device (81% vs 20%,p=0.01). In a multivariate logistic regression model, only non-aspiration device was an independent predictor of lower FT (OR 3.19, 95% CI 1.001-10.43). Lower FT was associated with lower total procedure time (80 vs 149 minutes, p<0.0001), favorable revascularization scores (TICI 2b and 3, 70% vs 38%, p=0.01), and 90 days MRS (41% vs 10%, p=0.01). Lower FT was associated with improved 3-month outcome after adjusting for age and admission NIHSS (OR 5.8 95% CI 1.3-44.5).
Conclusions: FT is an early predictor of 3 month clinical outcomes. The use of non-aspiration devices predicted lower FT and may reflect the complexity of using different devices. Occlusion at the ICA and cardiovascular comorbidities were also associated with prolonged FT. These results suggest that FT should be considered in the evaluation of device performance and followed as a measure of QI as this field rapidly evolves.