Background/Purpose: Acute ischemic stroke patients with large vessel occlusions are traditionally treated with thrombectomy within a 6-hour time window. Often patients get groin punctures for thrombectomy beyond 6 hours. The purpose of our study is to report real world data comparing short-term outcome differences in patients who receive groin punctures within 6 hours versus beyond 6 hours in a multi-hub telestroke network.
Method: Data obtained from the Providence Health and Services Get With the Guidelines stroke registry were used to identify AIS patients who received intra-arterial (IA) intervention and were discharged from the hospital between November 2014 and May 2016. Patients were categorized as having Last Known Well-to-Groin-Puncture times (LKW-to-GP) over six hours or LKW-to-GP below or equal to six hours. Outcomes were modified rankin score (mRS) at discharge (slight or no disability versus moderate disability to dead), discharge disposition (home versus not home), change in NIHSS from admittance to discharge, and length of stay (LOS). Multivariate analyses were used to determine impact of the LKW-to-GP group on outcomes adjusting for post thrombolysis in cerebral infarction (TICI) grade, pre-symptom onset mRS, and admission NIHSS score. Intracranial hemorrhage rates were compared between the two groups using Fisher’s exact test.
Results: We identified 136 ischemic stroke patients, 46.3% female with a mean age of 70.7 years (±14.6), who received IA intervention and were discharged between November 2014 and May 2016. Of those, 21% (n=29) had LKW-to-GP below or equal to six hours and 79% (n=107) had LKW-to-GP above six hours. After adjusting for covariates, there were no statistically significant differences in discharge mRS (p=.284), discharge disposition (p=.736), length of stay (p=.473) and change in NIHSS (p=.135). Unadjusted intracranial hemorrhage rates (p=.101) between the two LKW-to-GP groups were also not significant.
Conclusions: We discovered one in five patients were treated beyond the traditional time window in a multi-hub telestroke network. We found no statistically significant difference in short term outcomes in patients receiving thrombectomy beyond 6 hours compared to those receiving thrombectomy within 6 hours.