A
multicenter trial the results of which were published in Radiology by Goyal et al indicated
that if a patient with acute ischemic stroke is treated within two and half
hours of ictus, 91% recover with little or no disability. However after five and a half hours,
favorable outcome goes down to 41%.
Data from
196 patients enrolled in the SWIFT PRIME trial, a global, multicenter,
prospective study in which outcomes of patients treated with intravenous tissue
plasminogen activator tPA alone or in combination with a thrombectomy device (Solitaire
by Covidien, Irvine, CA) were analyzed.
In the
stent retriever arm of the study, symptom onset to reperfusion time of 150
minutes or less led to 91% estimated probability of functional independence,
which decreased by 10% over the next hour and by 20% with every subsequent hour
of delay. Time from arrival at the emergency department to arterial access was
90 minutes (interquartile range, 69–120 minutes), and time to reperfusion was
129 minutes (interquartile range, 108–169 minutes). Patients who initially
arrived at a referring facility had longer symptom onset to groin puncture
times compared with patients who presented directly to an endovascular-capable center
(275 versus 179.5 minutes, P < .001).
The
findings of the trial strongly suggest that fast reperfusion leads to improved
functional outcome among patients with acute stroke treated with stent
retrievers and tPA.
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