Neurointerventional Reports

A Multicenter Analysis of “Time to Microcatheter” for Endovascular Therapy in Acute Ischemic Stroke

Jefferson T. Miley MD

From the Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota and Hennepin County Medical Center, Minneapolis, MN.

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Muhammad Zeeshan Memon MD,

Muhammad Zeeshan Memon MD

From the Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota and Hennepin County Medical Center, Minneapolis, MN.

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Haitham M. Hussein MD,

Haitham M. Hussein MD

From the Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota and Hennepin County Medical Center, Minneapolis, MN.

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Douglas A. Valenta MD,

Douglas A. Valenta MD

From the Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota and Hennepin County Medical Center, Minneapolis, MN.

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M. Fareed K. Suri MD,

M. Fareed K. Suri MD

From the Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota and Hennepin County Medical Center, Minneapolis, MN.

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Gabriela Vazquez PhD,

Gabriela Vazquez PhD

From the Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota and Hennepin County Medical Center, Minneapolis, MN.

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Adnan I. Qureshi MD,

Adnan I. Qureshi MD

From the Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota and Hennepin County Medical Center, Minneapolis, MN.

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Jefferson T. Miley MD,

Jefferson T. Miley MD

From the Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota and Hennepin County Medical Center, Minneapolis, MN.

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Muhammad Zeeshan Memon MD,

Muhammad Zeeshan Memon MD

From the Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota and Hennepin County Medical Center, Minneapolis, MN.

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Haitham M. Hussein MD,

Haitham M. Hussein MD

From the Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota and Hennepin County Medical Center, Minneapolis, MN.

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Douglas A. Valenta MD,

Douglas A. Valenta MD

From the Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota and Hennepin County Medical Center, Minneapolis, MN.

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M. Fareed K. Suri MD,

M. Fareed K. Suri MD

From the Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota and Hennepin County Medical Center, Minneapolis, MN.

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Gabriela Vazquez PhD,

Gabriela Vazquez PhD

From the Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota and Hennepin County Medical Center, Minneapolis, MN.

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Adnan I. Qureshi MD,

Adnan I. Qureshi MD

From the Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota and Hennepin County Medical Center, Minneapolis, MN.

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First published: 24 March 2011

https://doi.org/10.1111/j.1552-6569.2009.00432.x

Citations: 21

Correspondence: Address correspondence to Jefferson T. Miley, MD, Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, 420 Delaware St. S.E., Minneapolis, MN 55455. E-mail: [email protected].

No grant support.

Data were presented in February 2009 at the International Stroke Conference in San Diego, CA.

J Neuroimaging 2011;21:159-164.

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Abstract

ABSTRACT

PURPOSE

At present, no time recommendation for initiation of endovascular treatment in acute ischemic stroke is available. A multicenter analysis was designed to identify variables that prolong “time to microcatheter,” defined as the time interval from computed tomographic scan to microcatheter placement in the cerebral circulation.

METHODS

Consecutive acute ischemic stroke patients from 3 academic stroke centers were included. Analysis of covariance was used to evaluate different variables that prolong “time to microcatheter.”

RESULTS

Ninety-one patients underwent emergent endovascular treatment for acute ischemic stroke. Mean “time to microcatheter” was 174 ± 60 minutes. No significant time difference was found in patients who were intubated, presented at night or weekends, were administered intravenous recombinant tissue plasminogen activator, or underwent additional imaging prior to endovascular treatment. “Time to microcatheter” was significantly longer in nonlevel I trauma centers and in patients with National Institutes of Health Stroke Scale Score of 10 to 19.

CONCLUSION

Wide variability of “time to microcatheter” among institutions highlights the need for standardized time goals.

References

1 National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333: 1581-1587.
10.1056/NEJM199512143332401
CAS PubMed Web of Science® Google Scholar
2 Hacke W, Donnan G, Fieschi C, et al. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 2004; 363: 768-774.
10.1016/S0140-6736(04)15692-4
PubMed Web of Science® Google Scholar
3 Tomsick T, Broderick J, Carrozella J, et al. Revascularization results in the Interventional Management of Stroke II trial. AJNR Am J Neuroradiol 2008; 29: 582-587.
10.3174/ajnr.A0843
CAS PubMed Web of Science® Google Scholar
4 Smith WS, Sung G, Starkman S, et al. Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke 2005; 36: 1432-1438.
10.1161/01.STR.0000171066.25248.1d
PubMed Google Scholar
5 Bose A, Henkes H, Alfke K, et al. The Penumbra System: a mechanical device for the treatment of acute stroke due to thromboembolism. AJNR Am J Neuroradiol 2008; 29: 1409-1413.
10.3174/ajnr.A1110
CAS PubMed Web of Science® Google Scholar
6 Smith WS. Safety of mechanical thrombectomy and intravenous tissue plasminogen activator in acute ischemic stroke. Results of the multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trial, part I. AJNR Am J Neuroradiol 2006; 27: 1177-1182.
CAS PubMed Web of Science® Google Scholar
7 Alberts MJ, Hademenos G, Latchaw RE, et al. Recommendations for the establishment of primary stroke centers. Brain Attack Coalition. JAMA 2000; 283: 3102-3109.
10.1001/jama.283.23.3102
CAS PubMed Web of Science® Google Scholar
8 Alberts MJ, Latchaw RE, Selman WR, et al. Recommendations for comprehensive stroke centers: a consensus statement from the Brain Attack Coalition. Stroke 2005; 36: 1597-1616.
10.1161/01.STR.0000170622.07210.b4
PubMed Web of Science® Google Scholar
9 Qureshi AI, Alkawi A, Hussein HM, et al. Angiographic analysis of intravascular thrombus volume in patients with acute ischemic stroke. J Endovasc Ther 2007; 14: 475-482.
10.1583/1545-1550(2007)14[475:AAOITV]2.0.CO;2
PubMed Web of Science® Google Scholar
10 Burns TC, Rodriguez GJ, Patel S, et al. Endovascular interventions following intravenous thrombolysis may improve survival and recovery in patients with acute ischemic stroke: a case-control study. AJNR Am J Neuroradiol 2008; 29: 1918-1924.
10.3174/ajnr.A1236
CAS PubMed Google Scholar
11 Qureshi AI, Janjua N, Kirmani JF, et al. Mechanical disruption of thrombus following intravenous tissue plasminogen activator for ischemic stroke. J Neuroimaging 2007; 17: 124-130.
10.1111/j.1552-6569.2007.00099.x
PubMed Google Scholar
12 Qureshi AI, Harris-Lane P, Kirmani JF, et al. Intra-arterial reteplase and intravenous abciximab in patients with acute ischemic stroke: an open-label, dose-ranging, phase I study. Neurosurgery 2006; 59: 789-796; discussion 796-797.
10.1111/j.1552-6569.2007.00099.x
PubMed Google Scholar
13 Qureshi AI, Siddiqui AM, Kim SH, et al. Reocclusion of recanalized arteries during intra-arterial thrombolysis for acute ischemic stroke. AJNR Am J Neuroradiol 2004; 25: 322-328.
PubMed Web of Science® Google Scholar
14 Qureshi AI, Hussein HM, Abdelmoula M, et al. Subacute recanalization and reocclusion in patients with acute ischemic stroke following endovascular treatment. Neurocrit Care 2009; 10(2): 195-203.
10.1007/s12028-008-9161-0
PubMed Web of Science® Google Scholar
15 Mayer SA, Copeland D, Bernardini GL, et al. Cost and outcome of mechanical ventilation for life-threatening stroke. Stroke 2000; 31: 2346-2353.
10.1161/01.STR.31.10.2346
CAS PubMed Web of Science® Google Scholar
16 Santoli F, De Jonghe B, Hayon J, et al. Mechanical ventilation in patients with acute ischemic stroke: survival and outcome at one year. Intensive Care Med 2001; 27: 1141-1146.
10.1007/s001340100998
CAS PubMed Web of Science® Google Scholar
17 Bushnell CD, Phillips-Bute BG, Laskowitz DT, et al. Survival and outcome after endotracheal intubation for acute stroke. Neurology 1999; 52: 1374-1381.
10.1212/WNL.52.7.1374
CAS PubMed Google Scholar
18 Saposnik G, Baibergenova A, Bayer N, et al. Weekends: a dangerous time for having a stroke? Stroke 2007; 38: 1211-1215.
10.1161/01.STR.0000259622.78616.ea
PubMed Web of Science® Google Scholar
19 De Silva DA, Ong SH, Elumbra D, et al. Timing of hospital presentation after acute cerebral infarction and patients’ acceptance of intravenous thrombolysis. Ann Acad Med Singapore 2007; 36: 244-246.
PubMed Web of Science® Google Scholar
20 Derex L, Adeleine P, Nighoghossian N, et al. Factors influencing early admission in a French stroke unit. Stroke 2002; 33: 153-159.
10.1161/hs0102.100533
PubMed Web of Science® Google Scholar
21 Maestroni A, Mandelli C, Manganaro D, et al. Factors influencing delay in presentation for acute stroke in an emergency department in Milan, Italy. Emerg Med J 2008; 25: 340-345.
10.1161/hs0102.100533
CAS PubMed Web of Science® Google Scholar
22 Bradley EH, Herrin J, Wang Y, et al. Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med 2006; 355: 2308-2320.
10.1056/NEJMsa063117
CAS PubMed Web of Science® Google Scholar
23 Lee KY, Kim DI, Kim SH, et al. Sequential combination of intravenous recombinant tissue plasminogen activator and intra-arterial urokinase in acute ischemic stroke. AJNR Am J Neuroradiol 2004; 25: 1470-1475.
PubMed Web of Science® Google Scholar
24 Smith WS, Sung G, Saver J, et al. Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke 2008; 39: 1205-1212.
10.1161/STROKEAHA.107.497115
PubMed Web of Science® Google Scholar
25 Schaefer PW, Yoo AJ, Bell D, et al. CT angiography-source image hypoattenuation predicts clinical outcome in posterior circulation strokes treated with intra-arterial therapy. Stroke 2008; 39: 3107-3109.
10.1161/STROKEAHA.107.497115
PubMed Web of Science® Google Scholar
26 Antman EM, Hand M, Armstrong PW, et al. 2007 Focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee. Circulation 2008; 117: 296-329.
PubMed Web of Science® Google Scholar
27 Wolfe T, Suarez JI, Tarr RW, et al. Comparison of combined venous and arterial thrombolysis with primary arterial therapy using recombinant tissue plasminogen activator in acute ischemic stroke. J Stroke Cerebrovasc Dis 2008; 17: 121-128.
10.1016/j.jstrokecerebrovasdis.2007.12.004
PubMed Google Scholar
28 Poncyljusz W, Falkowski A, Kojder I, et al. Treatment of acute ischemic brain infarction with the assistance of local intraarterial thrombolysis with recombinant tissue-type plasminogen activator. Acta Radiol 2007; 48: 774-780.
CAS PubMed Google Scholar
29 Ogawa A, Mori E, Minematsu K, et al. Randomized trial of intraarterial infusion of urokinase within 6 hours of middle cerebral artery stroke: the middle cerebral artery embolism local fibrinolytic intervention trial (MELT) Japan. Stroke 2007; 38: 2633-2639.
10.1161/STROKEAHA.107.488551
CAS PubMed Web of Science® Google Scholar
30 Shaltoni HM, Albright KC, Gonzales NR, et al. Is intra-arterial thrombolysis safe after full-dose intravenous recombinant tissue plasminogen activator for acute ischemic stroke? Stroke 2007; 38: 80-84.
10.1161/01.STR.0000251720.25337.b0
PubMed Google Scholar
31 Mattle HP, Arnold M, Georgiadis D, et al. Comparison of intraarterial and intravenous thrombolysis for ischemic stroke with hyperdense middle cerebral artery sign. Stroke 2008; 39: 379-383.
10.1161/STROKEAHA.107.492348
PubMed Google Scholar
32 Kim DJ, Kim DI, Byun JS, et al. Simple microwire and microcatheter mechanical thrombolysis with adjuvant intraarterial urokinase for treatment of hyperacute ischemic stroke patients. Acta Radiol 2008; 49: 351-357.
PubMed Google Scholar

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Volume21, Issue2

April 2011

Pages 159-164

A Multicenter Analysis of “Time to Microcatheter” for Endovascular Therapy in Acute Ischemic Stroke

Abstract

ABSTRACT

PURPOSE

METHODS

RESULTS

CONCLUSION

References

Citing Literature

References

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A Multicenter Analysis of “Time to Microcatheter” for Endovascular Therapy in Acute Ischemic Stroke

Abstract

ABSTRACT

PURPOSE

METHODS

RESULTS

CONCLUSION

References

Citing Literature

References

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