Introduction: Early hospital arrival form symptom onset has been related to the good outcome. However, it has been unknown whether in hyperacute recanalization therapy, early hospital arrival improves outcome in patients with and without large artery occlusion (LAO). We evaluated the association of onset-to-door (OTD) time with clinical outcome after hyperacute recanalization therapy in patients with and without LAO.
Methods: Consecutive stroke patients treated using hyperacute recanalization therapy including intravenous thrombolysis using tissue-plasminogen activator (tPA) and endovascular therapy (EVT) were studied. Good outcome was defined as mRS ≤2 at hospital discharge. All patients were divided into patient with and without LAO.
Results: From 2014 September to 2016 July, 129 (median age, 73 [64-82] years; 86 [67%] males) patients were analyzed. tPA alone was administered in 65 (50%) patients, EVT alone in 33 (26%), and tPA and EVT in 31 (24%). At discharge, 67 (52%) patients achieved the good outcome. Ninety-one patients (71%) were classified into the LAO group and 38 (29%) were into the non-LAO group. The OTD was similar between the LAO and the non-LAO groups (1.57 [0.87-3.42] h vs. 1.38 [0.76-2.68], p=0.420). Forty-six (51%) patients in the LAO and 21 (55%) patients in the non-LAO groups had good outcome (p=0.701). Regarding patients with LAO, age, OTD, and NIHSS score were significantly associated with good outcome (p=0.021, 0.014, and 0.001). Multivariate regression analysis also showed the OTD was the independent negative factor for good outcome (OR 0.77, 95%CI: 0.65-0.91, p=0.003). On the other hand, when we analyzed patients without LAO, OTD and NIHSS score were also significantly associated with good outcome (p=0.009, and 0.004). However, multivariate regression analysis did not show the OTD was the independent factor for good outcome (OR 0.83, 95%CI: 0.58-1.18, p=0.299). Only NIHSS score was independently related to it (OR 0.80, 95%CI: 0.67-0.96, p=0.018).
Conclusion: Impact of early hospital arrival on clinical outcome after hyperacute recanalization therapy differed between patients with and without LAO. In hyperacute recanalization therapy, early hospital arrival should improve outcome in patients with LAO but not without it.