Collateral status affects the onset-to-reperfusion time window for good outcome

Byung Moon Kim, Jang Hyun Baek, Ji Hoe Heo, Hyo Suk Nam, Young Dae Kim, Joonsang Yoo, Dong Joon Kim, Pyoung Jeon, Seung Kug Baik, Sang Hyun Suh, Kyung Yol Lee, Hyo Sung Kwak, Hong Gee Roh, Young Jun Lee, Sang Heum Kim, Chang Woo Ryu, Yon Kwon Ihn, Byungjun Kim, Hong Jun Jeon, Jin Woo KimJun Soo Byun, Sang-Il Suh, Jeong Jin Park, Woong Jae Lee, Jieun Roh, Byoung Soo Shin, Oh Young Bang

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Objective To characterise the time window in which endovascular thrombectomy (EVT) is associated with good outcome, and to test the differential relationship between functional outcome and onset-to-reperfusion time (ORT), depending on collateral status. Methods This was a retrospective analysis of clinical and imaging data of 554 consecutive patients, who had recanalisation success by EVT for anterior circulation large artery occlusion, from the prospectively maintained registries of 16 comprehensive stroke centres between September 2010 and December 2015. The patients were dichotomised into good and poor collateral groups, based on CT angiography. We tested whether the likelihood of good outcome (modified Rankin Scale, 0-2) by ORT was different between two groups. Results ORT was 298 min±113 min (range, 81-665 min), and 84.5% of patients had good collaterals. Age, diabetes mellitus, previous infarction, National Institutes of Health Stroke Scale, good collaterals (OR 40.766; 95% CI 10.668 to 155.78; p<0.001) and ORT (OR 0.926 every 30 min delay; 95% CI 0.862 to 0.995; p=0.037) were independently associated with good outcome. The drop in likelihood of good outcome associated with longer ORT was significantly faster in poor collateral group (OR 0.305 for every 30 min; 95% CI 0.113 to 0.822) than in good collateral group (OR 0.926 for every 30 min; 95% CI 0.875 to 0.980). Conclusions Earlier successful recanalisation was strongly associated with good outcome in poor collateral group; however, this association was weak during the tested time window in good collateral group. This suggests that the ORT window for good outcome can be adjusted according to collateral status.

Original languageEnglish
Pages (from-to)903-909
Number of pages7
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume89
Issue number9
DOIs
Publication statusPublished - 2018 Sep 1

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Psychiatry and Mental health

Fingerprint Dive into the research topics of 'Collateral status affects the onset-to-reperfusion time window for good outcome'. Together they form a unique fingerprint.

  • Cite this

    Kim, B. M., Baek, J. H., Heo, J. H., Nam, H. S., Kim, Y. D., Yoo, J., Kim, D. J., Jeon, P., Baik, S. K., Suh, S. H., Lee, K. Y., Kwak, H. S., Roh, H. G., Lee, Y. J., Kim, S. H., Ryu, C. W., Ihn, Y. K., Kim, B., Jeon, H. J., ... Bang, O. Y. (2018). Collateral status affects the onset-to-reperfusion time window for good outcome. Journal of Neurology, Neurosurgery and Psychiatry, 89(9), 903-909. https://doi.org/10.1136/jnnp-2017-317627