Thrombolysis-to-puncture time greater than 70 minutes decreases odds of successful thrombectomy

1. Thrombolysis-to-puncture time (TTP) >70 minutes significantly reduces the odds of successful recanalization and 90-day functional independence.

2. There was no increased risk of symptomatic intracranial hemorrhage (ICH) with shorter TTP.

Evidence Rating Level: 2 (Good)

This pooled analysis of 1,104 patients from two nationwide registries in China (ANGEL-ACT) and Germany (GSR-ET) investigated the relationship between thrombolysis-to-puncture time (TTP) and outcomes in patients with acute ischemic stroke (AIS) due to anterior circulation large vessel occlusion treated with intravenous thrombolysis (IVT) followed by endovascular thrombectomy (EVT). Patients were grouped by TTP intervals (≤30, 31–50, 51–70, and >70 minutes), and outcomes assessed included successful recanalization, functional independence at 90 days (mRS 0–2), and rates of intracranial hemorrhage (ICH). Multivariable analysis revealed that longer TTP was significantly associated with lower odds of successful recanalization and good functional outcome. Specifically, patients with TTP >70 minutes had reduced odds of successful recanalization (adjusted OR = 0.47) and mRS 0–2 (adjusted OR = 0.56) compared to those with TTP ≤30 minutes. No significant differences in symptomatic ICH were observed across TTP groups. These findings underscore the critical importance of minimizing in-hospital delays between IVT and EVT in bridging therapy. The results support current guidelines recommending against delaying thrombectomy to observe for IVT response.

Click to read the study in Neurology

Image: PD

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