In acute ischemic stroke patients, every second of delay in endovascular thrombectomy (EVT) treatment success is associated with a 2.4 hour loss of healthy life, according to a meta-analysis published in JAMA Neurology.
In this study, the researchers included all data published prior to August 2020 from the Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke (HERMES) collaboration. They assessed the clinical outcomes based on the therapy. Delayed treatment was defined as more than 4 to 12 hours from the time of the last known well to the arterial puncture (LKWTP). Any time point of 4 hours or less from LKWTP was considered early treatment.
EVT was administered to 781 of the 871 patients. Most of the patients who did not receive a thrombectomy had reperfusion prior to EVT or tortuous vessels preventing navigation to the occlusion.
Within the EVT cohort, 52.0% received early treatment and 48.0% received late treatment. The early and late groups included patients with a mean age of 66.2 years (standard deviation [SD], ± 13.4) and 64.7 (SD, ± 13.5) years, 46.6% and 47.2% were women, and reperfusion was achieved in 78.4% and 68.4%, respectively.
Each 1 hour delay from the last known period to reperfusion was with a loss of 0.84 (95% CI, 0.28-1.39) healthy years in the early group and 0.50 (95% CI , 0.07-0.92) healthy years in the group joined late group. Each 1-hour delay in arriving to the emergency room until reperfusion resulted in a loss of 0.84 (95% CI, 0.26-1.42) healthy years in the early group and 1.00 (95% – KI, 0.60-1.41) healthy years in the late group joined group.
In the early group patients, a 1 second delay in the door-to-puncture interval corresponded to a 2.2 hour loss of healthy life and a 1-second delay in the door-to-reperfusion interval corresponded to 2.4 hours of healthy life Lost life.
This study was constrained by the patient’s strict inclusion criteria and may not be generalizable.
The results indicated that timely reperfusion in patients with acute ischemic stroke was a significant factor in EVT results. The study’s researchers concluded: “Delays, especially after arriving at the hospital, until reperfusion is achieved, can result in significant loss of healthy years for patients. Efforts to optimize workflow and remove barriers that prevent timely patient assessment and treatment in health systems are justified. “
Disclosure: Several authors stated links to the pharmaceutical industry. For a full list of the details, see the original article.
Almekhlafi MA, Goyal M, Dippel DWJ et al. Healthy Lifetime Cost of Treatment Rate from Arrival to Endovascular Thrombectomy in Patients with Ischemic Stroke A meta-analysis of individual patient data from 7 randomized clinical trials. JAMA Neurol. 2021; 78 (6): 709-717. doi: 10.1001 / jamaneurol.2021.1055