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, Byungjoon Kim, Hong Jun Jeon, Jin Woo KimJun Soo Byun, Sangil Suh, Jeong Jin Park, Woong Jae Lee, Jieun Roh, Byoung Soo Shin, Oh Young Bang

Research output: Contribution to journalArticle

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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

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Reperfusion
Thrombectomy
Stroke
National Institutes of Health (U.S.)
Infarction
Registries
Diabetes Mellitus
Arteries

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology
  • Psychiatry and Mental health

Cite this

Kim, Byung Moon ; Baek, Jang Hyun ; Heo, Ji Hoe ; Nam, Hyo Suk ; Kim, Young Dae ; Yoo, Joonsang ; Kim, Dong Joon ; Jeon, Pyoung ; Baik, Seung Kug ; Suh, Sang Hyun ; Lee, Kyung Yol ; Kwak, Hyo Sung ; Roh, Hong Gee ; Lee, Young Jun ; Kim, Sang Heum ; Ryu, Chang Woo ; Ihn, Yon Kwon ; Kim, Byungjoon ; Jeon, Hong Jun ; Kim, Jin Woo ; Byun, Jun Soo ; Suh, Sangil ; Park, Jeong Jin ; Lee, Woong Jae ; Roh, Jieun ; Shin, Byoung Soo ; Bang, Oh Young. / Collateral status affects the onset-to-reperfusion time window for good outcome. In: Journal of Neurology, Neurosurgery and Psychiatry. 2018 ; Vol. 89, No. 9. pp. 903-909.
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title = "Collateral status affects the onset-to-reperfusion time window for good outcome",
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.",
author = "Kim, {Byung Moon} and Baek, {Jang Hyun} and Heo, {Ji Hoe} and Nam, {Hyo Suk} and Kim, {Young Dae} and Joonsang Yoo and Kim, {Dong Joon} and Pyoung Jeon and Baik, {Seung Kug} and Suh, {Sang Hyun} and Lee, {Kyung Yol} and Kwak, {Hyo Sung} and Roh, {Hong Gee} and Lee, {Young Jun} and Kim, {Sang Heum} and Ryu, {Chang Woo} and Ihn, {Yon Kwon} and Byungjoon Kim and Jeon, {Hong Jun} and Kim, {Jin Woo} and Byun, {Jun Soo} and Sangil Suh and Park, {Jeong Jin} and Lee, {Woong Jae} and Jieun Roh and Shin, {Byoung Soo} and Bang, {Oh Young}",
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Kim, BM, Baek, JH, Heo, JH, Nam, HS, Kim, YD, Yoo, J, Kim, DJ, Jeon, P, Baik, SK, Suh, SH, Lee, KY, Kwak, HS, Roh, HG, Lee, YJ, Kim, SH, Ryu, CW, Ihn, YK, Kim, B, Jeon, HJ, Kim, JW, Byun, JS, Suh, S, Park, JJ, Lee, WJ, Roh, J, Shin, BS & Bang, OY 2018, 'Collateral status affects the onset-to-reperfusion time window for good outcome', Journal of Neurology, Neurosurgery and Psychiatry, vol. 89, no. 9, pp. 903-909. https://doi.org/10.1136/jnnp-2017-317627

Collateral status affects the onset-to-reperfusion time window for good outcome. / Kim, Byung Moon; Baek, Jang Hyun; Heo, Ji Hoe; Nam, Hyo Suk; Kim, Young Dae; Yoo, Joonsang; Kim, Dong Joon; Jeon, Pyoung; Baik, Seung Kug; Suh, Sang Hyun; Lee, Kyung Yol; Kwak, Hyo Sung; Roh, Hong Gee; Lee, Young Jun; Kim, Sang Heum; Ryu, Chang Woo; Ihn, Yon Kwon; Kim, Byungjoon; Jeon, Hong Jun; Kim, Jin Woo; Byun, Jun Soo; Suh, Sangil; Park, Jeong Jin; Lee, Woong Jae; Roh, Jieun; Shin, Byoung Soo; Bang, Oh Young.

In: Journal of Neurology, Neurosurgery and Psychiatry, Vol. 89, No. 9, 01.09.2018, p. 903-909.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Collateral status affects the onset-to-reperfusion time window for good outcome

AU - Kim, Byung Moon

AU - Baek, Jang Hyun

AU - Heo, Ji Hoe

AU - Nam, Hyo Suk

AU - Kim, Young Dae

AU - Yoo, Joonsang

AU - Kim, Dong Joon

AU - Jeon, Pyoung

AU - Baik, Seung Kug

AU - Suh, Sang Hyun

AU - Lee, Kyung Yol

AU - Kwak, Hyo Sung

AU - Roh, Hong Gee

AU - Lee, Young Jun

AU - Kim, Sang Heum

AU - Ryu, Chang Woo

AU - Ihn, Yon Kwon

AU - Kim, Byungjoon

AU - Jeon, Hong Jun

AU - Kim, Jin Woo

AU - Byun, Jun Soo

AU - Suh, Sangil

AU - Park, Jeong Jin

AU - Lee, Woong Jae

AU - Roh, Jieun

AU - Shin, Byoung Soo

AU - Bang, Oh Young

PY - 2018/9/1

Y1 - 2018/9/1

N2 - 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.

AB - 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.

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U2 - 10.1136/jnnp-2017-317627

DO - 10.1136/jnnp-2017-317627

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