Abstract TP24

Time from Symptoms Onset to Revascularization Impact on Outcomes in Revascularized Swift Trial Patients

Zaidat, Osama
Lazzaro, Marc A
Brown, Scott
Nogueira, Raul G
Gupta, Rishi
Jovin, Tudor
Siddiqui, Adnan
Yavagal, Dileep
Clark, Wayne
Saver, Jeffrey L

¹Med College of Wisconsin, Milwaukee, WI
²ev3, Plymouth, MN
³Emory, Atlanta, GA
⁴Univ of Pittsburgh, Pittsburgh, PA
⁵Univ of Buffalo, Buffalo, NY
⁶Univ of Miami, Miami, FL
⁷OHSU, Portland, OR
⁸UCLA, LA, CA

Author Disclosures: O. Zaidat: Consultant/Advisory Board; Modest; Stryker, Covedian, Penumbra and Codman. M.A. Lazzaro: None. S. Brown: Employment; Modest; ev3. R.G. Nogueira: Consultant/Advisory Board; Modest; stryker, ev3. R. Gupta: None. T. Jovin: Consultant/Advisory Board; Modest; Covidien, Stryker, Silk Road Medical. A. Siddiqui: Consultant/Advisory Board; Modest; stryker, codman, ev3. D. Yavagal: Other Research Support; Modest; Anderson Family Gift to Division of Interventional Neurolgy. Consultant/Advisory Board; Modest; Aldagen/Cytomedix. Other; Modest; Steering Committee Member of RECOVER-STROKE clinical trial. Research Grant; Significant; James and Esther King New Investigator Research Grant: 2011-2014. W. Clark: None. J.L. Saver: None.

Stroke 44(2_MeetingAbstracts), February 2013.

Introduction: Time from symptoms onset to revascularization (TOR) has been shown to be is an important predictor of clinical outcomes in mechanical thrombectomy for acute ischemic stroke (AIS). In this study, we sought to assess the influence of TOR on outcomes in the multicenter, randomized Solitaire FR with the Intention for Thrombectomy (SWIFT) trial.

Methods: AIS patients enrolled in the SWIFT trial who achieved the primary endpoint of successful recanalization without hemorrhage (SR-sICH) were included. The TOR was the main predictor variable. The main outcome variables were the 90 days modified Rankin’s Scale (mRS) ≤ 2; good neurologic outcome (Rankin’s Scale (mRS) ≤ 2 or NIHSS Improvement of ≥10), and mortality. P-values were calculated using Wilcoxon, linear regression, Cochran Mantel-Haenzsel, or Fischer exact tests.

Results: A total of 63 patients achieved SR-sICH and were included in this analysis. 57% patients had a good clinical outcome of mRS ≤ 2, with a mean TOR of 310(74) minutes vs. 348(80) minutes in those with mRS>2 at 90 days, p=0.08. Patients who died (19%) had a statistically longer TOR than survivors (TOR of 270(75) minutes versus 320(75) minutes in the survivors, p=0.04). Patients in lower quartiles had a trend toward improved neurological outcome and mortality (p=0.2 and p=0.1). When dichotomizing TOR to ≤6.5 hours (n=50) versus >6.5 hours (n=13), a trend toward better clinical outcome was noted in the ≤ 6.5 hours group; mRS ≤ 2 at 90-day (46% vs. 17%, p=0.008); with a trend toward improved good neurological outcome and mRS at 90 days (66% and 55% with p=0.19 and p=0.1, respectively) with no difference in mortality. A multivariate analysis model for predicting mRS at 90 days showed TOR as a significant predictor of neurological outcome (p=0.02).

Conclusions: A shorter time from TOR is associated with improved functional neurological outcome at 90 days in revascularized SWIFT trial patients.