Supplementary Material for: Effect of needle-to-puncture time on reperfusion outcome in acute ischemic stroke

Introduction To investigate the impact of time interval between start of intravenous thrombolysis (IVT) to start of endovascular thrombectomy (EVT) on stroke outcomes. Methods Data from the Quality Improvement and Clinical Research (QuICR) provincial stroke registry from Alberta, Canada was used to identify stroke patients who received IVT and EVT from January 2015 to December 2019. We assessed the impact of the time interval between IVT bolus to EVT puncture (needle-to-puncture times “NPT”) on outcomes. Radiological outcomes included successful initial recanalization (revised arterial occlusive lesion 2b–3), successful initial and final reperfusion (modified thrombolysis in cerebral infarction 2b–3). Clinical outcomes were 90-day modified Rankin Scale (mRS) and mortality. Results Of the 680 patients, 233 patients (median age 73, 41% females) received IVT+EVT. Median NPT was 38 minutes (IQR, 24–60). Arrival during working hours was independently associated with shorter NPT (P < 0.001). Successful initial recanalization, initial and final reperfusion were observed in 12%, 10% and 83% of patients, respectively. NPT was not associated with initial successful recanalization (OR 0.97 for every 10-minute increase of NPT, 95% CI 0.91 – 1.04), initial successful reperfusion (OR 1.01, 95% CI 0.96 – 1.07), or final successful reperfusion (OR 1.03, 95% CI 0.97 – 1.08). Every 10-minute delay in NPT was associated with lower odds of functional independence at 90 days (mRS ≤ 2; OR 0.93; 95% CI, 0.88–0.97). Patients with shorter NPT (≤ 38 min) had lower 90-day mRS scores (median 1 vs 3; OR 0.54 [0.31–0.91]) and had lower mortality (6.1% vs 21.2%; OR, 0.23 [0.10–0.57]) than the longer NPT group. Conclusion Shorter NPT did not impact reperfusion outcomes, but was associated with better clinical outcome.

引言：本研究旨在探讨静脉溶栓（intravenous thrombolysis, IVT）启动至血管内取栓（endovascular thrombectomy, EVT）启动的时间间隔对卒中预后的影响。
方法：本研究使用加拿大阿尔伯塔省质量改进与临床研究（Quality Improvement and Clinical Research, QuICR）省级卒中登记库的数据，纳入2015年1月至2019年12月期间接受IVT联合EVT的卒中患者。我们评估了IVT推注至EVT穿刺（针-穿刺时间，needle-to-puncture times, NPT）的时间间隔对预后的影响。影像学结局包括首次成功再通（改良动脉闭塞病变评分2b~3级）、首次及最终成功再灌注（脑梗死溶栓改良评分（modified thrombolysis in cerebral infarction, mTICI）2b~3级）。临床结局为90天改良Rankin量表（modified Rankin Scale, mRS）评分及死亡率。
结果：共纳入680例患者，其中233例（中位年龄73岁，女性占41%）接受了IVT+EVT治疗。中位NPT为38分钟（四分位距[interquartile range, IQR]：24~60）。工作时段就诊与更短的NPT独立相关（P < 0.001）。首次成功再通、首次成功再灌注及最终成功再灌注的患者占比分别为12%、10%和83%。NPT与首次成功再通（NPT每增加10分钟，比值比（odds ratio, OR）为0.97，95%置信区间（confidence interval, CI）0.91~1.04）、首次成功再灌注（OR=1.01，95%CI 0.96~1.07）及最终成功再灌注（OR=1.03，95%CI 0.97~1.08）均无显著关联。NPT每延迟10分钟，患者90天功能独立（mRS≤2）的比值比降低（OR=0.93；95%CI 0.88~0.97）。与NPT较长组相比，NPT较短组（≤38 min）患者的90天mRS评分更低（中位值1 vs 3；OR=0.54[0.31~0.91]），死亡率更低（6.1% vs 21.2%；OR=0.23[0.10~0.57]）。
结论：更短的NPT未对再灌注结局产生影响，但与更佳的临床预后相关。