Cerebral venous outflow profiles are associated with the first pass effect in endovascular thrombectomy

BackgroundRecent studies found that favorable venous outflow (VO) profiles are associated with higher reperfusion rates after mechanical thrombectomy (MT) in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). Fewer retrieval attempts and first-pass revascularization during MT lead to better functional outcomes.ObjectiveTo examine the hypothesis that favorable VO profiles assessed on baseline CT angiography (CTA) images correlate with successful vessel reperfusion after the first retrieval attempt and fewer retrieval attempts.MethodsA multicenter retrospective cohort study of patients with AIS-LVO treated by MT. Baseline CTA was used to determine the cortical vein opacification score (COVES). Favorable VO was defined as COVES ≥3. Primary outcomes were successful with excellent vessel reperfusion status, defined as Thrombolysis in Cerebral Infarction (TICI) 2b/3 and 2c/3 after first retrieval attempt.Results617 patients were included in this study, of whom 205 (33.2%) had first pass reperfusion. In univariate analysis, ordinal COVES (p=0.011) values were significantly higher in patients with first pass than in those with non-first pass reperfusion, while the number of patients exhibiting favorable pial arterial collaterals using the Maas scale on CTA did not differ (p=0.243). In multivariable logistic regression analysis, higher COVES were independently associated with TICI 2b/3 (OR=1.25, 95% CI 1.1 to 1.42; p=0.001) and TICI 2c/3 (OR=1.2, 95% CI 1.04 to 1.36; p=0.011) reperfusion after one retrieval attempt, controlling for penumbra volume and time from symptom onset to vessel reperfusion.ConclusionsFavorable VO, classified as higher COVES, is independently associated with successful and excellent first pass reperfusion in patients with AIS-LVO treated by endovascular thrombectomy.

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Association of Venous Outflow Profiles and Successful Vessel Reperfusion After Thrombectomy

Neurology ◽

10.1212/wnl.0000000000012106 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012106

Author(s):

Tobias Djamsched Faizy ◽

Reza Kabiri ◽

Soren Christensen ◽

Michael Mlynash ◽

Gabriella Kuraitis ◽

...

Keyword(s):

Functional Outcome ◽

Tissue Perfusion ◽

Secondary Outcome ◽

Multivariable Logistic Regression Analysis ◽

Venous Outflow ◽

Vessel Occlusion ◽

Endovascular Thrombectomy ◽

Cortical Vein ◽

Good Functional Outcome ◽

Pre Treatment

Objective:Robust arterial collaterals are associated with successful reperfusion after thrombectomy treatment of acute ischemic stroke due to large vessel occlusion (AIS-LVO). Excellent venous outflow (VO) reflects excellent tissue perfusion and collateral status in AIS-LVO patients. To determine whether favorable VO profiles assessed on pre-treatment CT angiography (CTA) images correlate with successful vessel reperfusion after thrombectomy in AIS-LVO patients.Methods:Multicenter retrospective cohort study of consecutive AIS-LVO patients treated by thrombectomy. Baseline CTA was used to assess collateral status (Tan scale) and VO using the cortical vein opacification score (COVES). Favorable VO was defined as COVES ≥3. Primary outcome was excellent vessel reperfusion status (modified Thrombolysis In Cerebral Infarction [TICI] 2c-3). Secondary outcome was good functional outcome defined as 0-2 on the Modified Ranking Scale (mRS) after 90 days.Results:565 patients met inclusion criteria. Multivariable logistic regression analysis showed that favorable VO (OR= 2.10 [95% CI 1.39-3.16]; p<0.001) was associated with excellent vessel reperfusion during thrombectomy, regardless of good CTA collateral status (OR= 0.87 [95%CI 0.58-1.34]; p=0.48). A favorable VO profile (OR= 8.9 [95%CI 5.3-14.9]; p<0.001) and excellent vessel reperfusion status (OR = 2.7 [95%CI 1.7-4.4]; p<0.001) were independently associated with good functional outcome adjusted for age, sex, glucose, tPA administration, good CTA collateral status and presentation NIHSS.Conclusion:A favorable VO profile is associated with reperfusion success and good functional outcomes in patients with AIS-LVO treated by endovascular thrombectomy.

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Abstract WP502: Predictors Of First Pass Reperfusion In Anterior Circulation Large Vessel Occlusion Stroke

Stroke ◽

10.1161/str.51.suppl_1.wp502 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Mahmoud Mohammaden ◽

Leonardo Pisani ◽

Catarina Perry da Camara ◽

Mehdi Bousalma ◽

Alhamza Al bayati ◽

...

Keyword(s):

Mechanical Thrombectomy ◽

Univariate Analysis ◽

Multivariate Regression Analysis ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Performance Metric ◽

First Pass ◽

Thrombectomy Device

Introduction: The speed and completeness of endovascular reperfusion strongly correlate with functional outcomes. First-Pass Reperfusion (FPR) has been recently established as a critical procedural performance metric for mechanical thrombectomy (MT). We aimed to study the predictors of FPR and its effect on the outcome Methods: Review of a prospectively collected database of MT patients with large vessel occlusion strokes (LVOS) from 05/2012-11/2018. Patients were included in the analysis if they had an anterior circulation LVOS that was successfully reperfused (mTICI 2b-3). FPR was defined as the achievement of mTICI 2c-3 after a single pass with any thrombectomy device. Uni- and multivariate analyses were performed to identify the independent predictors of FPR. Results: A total of 563 patients qualified for the analysis (mean age, 64.4±12.3 years, baseline NIHSS 16.2). FPR was achieved in 202 (35.9%) patients. On univariate analysis, FPR was significantly associated with higher ASPECTS (8.1 vs. 7.8, p=0.008), higher usage of balloon guide catheters (BGC) (88.1% vs. 75.3%, p<0.001), lower use of general anesthesia (9.5% vs. 18.2%, p= 0.006), and shorter procedure duration (mean, 45.5 vs. 79.9 min, p <0.001 and 90.5%). Both BGC (OR, 2.26; 95%CI [1.32-3.87], p=0.003) and ASPECTS (OR, 1.15; 95% CI [1.03-1.28], p= 0.01) were independent predictors of FPE on multivariate regression analysis. Conclusion: Higher baseline ASPECTS score and the use of BGC are strong predictors of First-Pass Reperfusion in mechanical thrombectomy.

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Abstract TP28: Intravenous Thrombolysis is Associated With Better Functional Outcomes in Endovascular Thrombectomy Patients Requiring Multiple-Passes to Achieve Reperfusion

Stroke ◽

10.1161/str.51.suppl_1.tp28 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Christopher Blair ◽

Cecilia Cappelen-Smith ◽

Dennis Cordato ◽

Leon Edwards ◽

Amer Mitchelle ◽

...

Keyword(s):

Functional Outcomes ◽

Intravenous Thrombolysis ◽

Functional Independence ◽

Independent Effect ◽

Large Vessel Occlusion ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Endovascular Thrombectomy ◽

Multiple Pass ◽

First Pass

Introduction: In patients with anterior circulation stroke with large vessel occlusion (LVO), recent data suggest that successful reperfusion (mTICI≥2b) after a single device pass results in more favourable functional outcomes in comparison to patients requiring multiple passes. It is unclear if this effect represents an epiphenomenon or a true independent effect. Methods: A prospectively maintained database of EVT was interrogated for patients presenting with anterior circulation LVO with onset to groin puncture times of ≤ 6 hours from January 2016 to March 2019. Three-month functional outcomes were compared between first-pass reperfusion and multiple-pass reperfusion patients using logistic regression. Results: A total of 169 patients were identified (mean age 71 yrs, 44% female, median NIHSS 17, intravenous thrombolysis (IVT) in 47%). Successful reperfusion (mTICI≥2b) was achieved with the first-pass (FP) in 80 patients (47%) and multiple-passes (MP) in 89 patients (53%). First pass patients had better outcomes when compared to MP patients (mRS 0-2 71% vs 31%, p < 0.001). No difference in functional outcomes was seen between FP patients who received IVT and those that did not (mRS 0-2 68% vs 75%, p = 0.459). Multiple-pass patients who received IVT achieved higher rates of functional independence than those who did not (mRS 0-2 40% vs 27%, p = 0.035). Conclusion: Intravenous thrombolysis may improve functional recovery in EVT patients requiring multiple-passes to achieve reperfusion. Prospective studies should be considered.

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Impact of onset-to-groin puncture time within three hours on functional outcomes in mechanical thrombectomy for acute large-vessel occlusion

Interventional Neuroradiology ◽

10.1177/1591019917747247 ◽

2017 ◽

Vol 24 (2) ◽

pp. 162-167 ◽

Cited By ~ 3

Author(s):

Takahiro Ota ◽

Yasuhiro Nishiyama ◽

Satoshi Koizumi ◽

Tomonari Saito ◽

Masayuki Ueda ◽

...

Keyword(s):

Scale Score ◽

Functional Outcomes ◽

Mechanical Thrombectomy ◽

Large Vessel ◽

Multivariable Logistic Regression Analysis ◽

Large Vessel Occlusion ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Stroke Treatment ◽

The Impact

Introduction Endovascular treatment for acute ischemic stroke with acute large-vessel occlusion (ALVO) has established benefits, and rapid treatment is vital for mechanical thrombectomy in ALVO. Time from onset of stroke to groin puncture (OTP) is a practical and useful clinical marker, and OTP should be shortened to obtain the maximum benefit of thrombectomy. Objective The aim of the present study was to assess the impact of early treatment of anterior circulation stroke within three hours after symptom onset and to evaluate the role of OTP in determining outcomes after endovascular therapy. Methods Consecutive patients with acute stroke due to major artery (internal carotid or middle cerebral arteries) occlusion who underwent endovascular recanalization between March 2014 and January 2017 were retrospectively evaluated. Patients were stratified by OTP into three categories: 0–≤3 h, >3–≤6 h, and >6 h. The primary outcome measure was a 90-day modified Rankin scale score of 0–2 (good outcome). Results Data were analyzed from 100 patients (mean age, 76.6 years; mean National Institutes of Health Stroke Scale score, 17). Groin puncture occurred within 0–≤3 h in 51 patients, >3–≤6 h in 28, and >6 h in 21. Median OTP in each group was 126 min (range, 57–168 min), 238 min (range, 186–360 min) and 728 min (range, 365–1492 min), respectively. On multivariable logistic regression analysis, category of OTP represented an independent predictor of patient outcome (adjusted odds ratio, 0.48; 95% confidence interval, 0.25–0.93; p = 0.029). Conclusions OTP is a prehospital and in-hospital workflow-based indicator. In this single-center study, OTP was found to independently affect functional outcomes after endovascular stroke treatment.

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Abstract P504: Outcomes and Predictors of Successful First Pass in MCA Occlusions Using ADAPT Thrombectomy Technique - Insights From STAR

Stroke ◽

10.1161/str.52.suppl_1.p504 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Eyad Almallouhi ◽

Sami Al Kasab ◽

Ali Alawieh ◽

Mais Al-Kawaz ◽

Robert Starke ◽

...

Keyword(s):

Mechanical Thrombectomy ◽

Independent Predictor ◽

Multivariable Analysis ◽

Multivariable Logistic Regression Analysis ◽

Single Center ◽

Number Of Patients ◽

First Pass ◽

History Of ◽

The Relationship ◽

Iv Tpa

Introduction: Successful first pass (SFP) has been identified as a key benchmark of the success of mechanical thrombectomy (MT). However, studies that evaluate the predictors and outcomes of SFP using ADAPT (A Direct Aspiration first Pass Technique) are limied by the small number of patients or single center design. Methods: We used data from the prospectively collected data from 28 stroke centers that are included in the Stroke Thrombectomy and Aneurysm Registry (STAR). Patients with middle cerebral artery (MCA) occlusions at the level of M1 or M2 segments were included. SFP was defined by achieving modified Thrombolysis in Cerebral Infarction (mTICI) score≥2b with a single aspiration attempt. A multivariable logistic regression analysis was used to assess the predictors of SFP and evaluate the relationship between SFP and favorable 90-day outcome (90-day modified Rankin scale ≤2). Results: Out of 6123 patients included in STAR, 1002 (16.4%) underwent MT of M1 or M2 occlusion using ADAPT technique. SFP was achieved in 390 (38.9%) patients. SFP patients were older (72 vs. 69, P=0.007), had higher Alberta Stroke Program Early CT Score (ASPECTS) on presentation (9 vs. 8, P=0.018) (Table 1). On multivariable analysis, neither age (aOR 1.006, 95% CI 0.996-1.016, P=0.252) nor ASPECTS (aOR 1.055, 95% CI 0.976-1.141, P=0.179) were independent predictor of SFP. Importantly, SFP was independently associated with favorable 90-day outcome (aOR 2.769, 95% CI 1.988-3.858, P<0.001) after controlling for age, sex, ASPECTS, history of atrial fibrillation, NIHSS on presentation, onset to groin time and IV-tPA. Conclusion: In this cohort of patients with M1 or M2 occlsuion undergoing MT using ADAPT technique, patients who had SFP were older and had better ASPECTS. However, both age and ASPECTS were not independently associated with SFP. Also, patients who had SFP were almost 3 times more likely to achieve favorable 90-day outcome.

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Venous outflow profiles are associated with early edema progression in ischemic stroke

International Journal of Stroke ◽

10.1177/17474930211065635 ◽

2022 ◽

pp. 174749302110656

Author(s):

Noel van Horn ◽

Jeremy J Heit ◽

Reza Kabiri ◽

Gabriel Broocks ◽

Soren Christensen ◽

...

Keyword(s):

Ischemic Stroke ◽

Functional Outcomes ◽

Secondary Outcome ◽

Outcome Analysis ◽

Progression Rate ◽

Infarct Core ◽

Venous Outflow ◽

Vessel Occlusion ◽

Ischemic Brain ◽

Cortical Vein

Background: In patients with acute ischemic stroke due to large vessel occlusion (AIS–LVO), development of extensive early ischemic brain edema is associated with poor functional outcomes, despite timely treatment. Robust cortical venous outflow (VO) profiles correlate with favorable tissue perfusion. We hypothesized that favorable VO profiles (VO+) correlate with a reduced early edema progression rate (EPR) and good functional outcomes. Methods: Multicenter, retrospective analysis to investigate AIS–LVO patients treated by mechanical thrombectomy between May 2013 and December 2020. Baseline computed tomography angiography (CTA) was used to determine VO using the cortical vein opacification score (COVES); VO+ was defined as COVES ⩾ 3 and unfavorable as COVES ⩽ 2. EPR was determined as the ratio of net water uptake (NWU) on baseline non-contrast CT and time from symptom onset to admission imaging. Multivariable regression analysis was performed to assess primary (EPR) and secondary outcome (good functional outcomes defined as 0–2 points on the modified Rankin scale). Results: A total of 728 patients were included. Primary outcome analysis showed VO+ (β: –0.03, SE: 0.009, p = 0.002), lower presentation National Institutes of Health Stroke Scale (NIHSS; β: 0.002, SE: 0.001, p = 0.002), and decreased time from onset to admission imaging (β: –0.00002, SE: 0.00004, p < 0.001) were independently associated with reduced EPR. VO+ also predicted good functional outcomes (odds ratio (OR): 5.07, 95% CI: 2.839–9.039, p < 0.001), while controlling for presentation NIHSS, time from onset to imaging, general vessel reperfusion, baseline Alberta Stroke Program Early CT Score, infarct core volume, EPR, and favorable arterial collaterals. Conclusions: Favorable VO profiles were associated with slower infarct edema progression and good long-term functional outcomes as well as better neurological status and ischemic brain alterations at admission.

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Improving mechanical thrombectomy time metrics in the angiography suite: Stroke cart, parallel workflows, and conscious sedation

Interventional Neuroradiology ◽

10.1177/1591019917742326 ◽

2017 ◽

Vol 24 (2) ◽

pp. 168-177 ◽

Cited By ~ 3

Author(s):

Fabio Settecase ◽

David B McCoy ◽

Robert Darflinger ◽

Matthew D Alexander ◽

Daniel L Cooke ◽

...

Keyword(s):

Functional Outcomes ◽

Mechanical Thrombectomy ◽

Conscious Sedation ◽

Vessel Occlusion ◽

Angiography Suite ◽

Number Of Patients ◽

Number Of Passes ◽

Room Time ◽

Time Type ◽

Clot Time

Purpose Earlier reperfusion of large-vessel occlusion (LVO) stroke improves functional outcomes. We hypothesize that use of a stroke cart in the angiography suite, containing all commonly used procedural equipment in a mechanical thrombectomy, combined with parallel staff workflows, and use of conscious sedation when possible, improve mechanical thrombectomy time metrics. Methods We identified 47 consecutive LVO patients who underwent mechanical thrombectomy at our center, retrospectively and prospectively from implementation of these three workflow changes (19 pre- and 28 post-). For each patient, last known normal, NIHSS, angiography suite in-room time, type of anesthesia, groin puncture time, on-clot time, recanalization time, LVO location, number of passes, device(s) used, mTICI score, and outcome (mRS) were recorded. Between-group comparisons of time metrics and multivariate regression were performed. Results Stroke cart, parallel workflows, and primary use of conscious sedation decreased in-room time to groin puncture (−21.3 min, p < 0.0001), in-room to on-clot time (−24.1 min, p = 0.001), and in-room to reperfusion time (−29.5 min, p = 0.01). In a multivariate analysis, endotracheal intubation and general anesthesia were found to significantly increase in-room to on-clot time ( p = 0.01), in-room to reperfusion time ( p = 0.01), and groin puncture to on-clot time ( p = 0.05). The number of patients achieving a good outcome (mRS 0−2), however, did not significantly differ between the two groups (9/18 (47%) vs 14/28 (50%), p = 0.60). Conclusions Use of a stroke cart, parallel workflows by neurointerventionalists, technologists, and nursing staff, and use of conscious sedation may be useful to other institutions in efforts to improve procedural times.

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Feasibility and safety of the strategy of first stenting without retrieval using Solitaire FR as a treatment for emergent large-vessel occlusion due to underlying intracranial atherosclerosis

Journal of Neurosurgery ◽

10.3171/2020.8.jns202504 ◽

2021 ◽

pp. 1-9

Author(s):

Jong-Hoon Kim ◽

Young-Jin Jung ◽

Chul-Hoon Chang

Keyword(s):

Functional Outcomes ◽

Medical Center ◽

Large Vessel ◽

Intracranial Atherosclerosis ◽

Large Vessel Occlusion ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Stent Retrieval ◽

First Pass ◽

Solitaire Fr

OBJECTIVEThe optimal treatment for underlying intracranial atherosclerosis (ICAS) in patients with emergent large-vessel occlusion (ELVO) remains unclear. Reocclusion during endovascular treatment (EVT) occurs frequently (57.1%–77.3%) after initial recanalization with stent retriever (SR) thrombectomy in ICAS-related ELVO. This study aimed to compare treatment outcomes of the strategy of first stenting without retrieval (FRESH) using the Solitaire FR versus SR thrombectomy in patients with ICAS-related ELVO.METHODSThe authors retrospectively reviewed consecutive patients with acute ischemic stroke and intracranial ELVO of the anterior circulation who underwent EVT between January 2017 and December 2019 at Yeungnam University Medical Center. Large-vessel occlusion (LVO) of the anterior circulation was classified by etiology as follows: 1) no significant stenosis after recanalization (embolic group) and 2) remnant stenosis > 70% or lesser degree of stenosis with a tendency toward reocclusion and/or flow impairment during EVT (ICAS group). The ICAS group was divided into the SR thrombectomy group (SR thrombectomy) and the FRESH group.RESULTSA total of 105 patients (62 men and 43 women; median age 71 years, IQR 62.5–79 years) were included. The embolic, SR thrombectomy, and FRESH groups comprised 66 (62.9%), 26 (24.7%), and 13 (12.4%) patients, respectively. There were no significant differences between the SR thrombectomy and FRESH groups in symptom onset–to-door time, but puncture-to-recanalization time was significantly shorter in the latter group (39 vs 54 minutes, p = 0.032). There were fewer stent retrieval passes but more first-pass recanalizations in the FRESH group (p < 0.001). Favorable functional outcomes were significantly more frequent in the FRESH group (84.6% vs 42.3%, p = 0.017).CONCLUSIONSThis study’s findings suggest that FRESH, rather than rescue stenting, could be a treatment option for ICAS-related ELVO.

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Successful mechanical thrombectomy in acute ischemic stroke: revascularization grade and functional independence

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-018436 ◽

2022 ◽

pp. neurintsurg-2021-018436

Author(s):

Sherief Ghozy ◽

Salah Eddine Oussama Kacimi ◽

Ahmed Y Azzam ◽

Ramadan Abdelmoez Farahat ◽

Abdelaziz Abdelaal ◽

...

Keyword(s):

Systematic Review ◽

Functional Outcomes ◽

Mechanical Thrombectomy ◽

Meta Analysis ◽

Functional Independence ◽

Complete Revascularization ◽

Modified Rankin Scale ◽

Technical Success ◽

Endovascular Thrombectomy ◽

Quantitative Synthesis

Most studies define the technical success of endovascular thrombectomy (EVT) as a Thrombolysis in Cerebral Infarction (TICI) revascularization grade of 2b or higher. However, growing evidence suggests that TICI 3 is the best angiographic predictor of improved functional outcomes. To assess the association between successful TICI revascularization grades and functional independence at 90 days, we performed a systematic review and network meta-analysis of thrombectomy studies that reported TICI scores and functional outcomes, measured by the modified Rankin Scale, using the semi-automated AutoLit software platform. Forty studies with 8691 patients were included in the quantitative synthesis. Across TICI, modified TICI (mTICI), and expanded TICI (eTICI), the highest rate of good functional outcomes was observed in patients with TICI 3 recanalization, followed by those with TICI 2c and TICI 2b recanalization, respectively. Rates of good functional outcomes were similar among patients with either TICI 2c or TICI 3 grades. On further sensitivity analysis of the eTICI scale, the rates of good functional outcomes were equivalent between eTICI 2b50 and eTICI 2b67 (OR 0.81, 95% CI 0.52 to 1.25). We conclude that near complete or complete revascularization (TICI 2c/3) is associated with higher rates of functional outcomes after EVT.

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Abstract TP50: A Critical Assessment of the Golden Hour and the Impact of Procedural Timing in Stroke Thrombectomy: A Single-Center Study

Stroke ◽

10.1161/str.51.suppl_1.tp50 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Aaron P Wessell ◽

Helio De Paula Carvahlo ◽

Elizabeth Le ◽

Gregory Cannarsa ◽

Matthew J Kole ◽

...

Keyword(s):

Logistic Regression ◽

Mechanical Thrombectomy ◽

Univariate Analysis ◽

Multivariable Logistic Regression Analysis ◽

Procedure Time ◽

Golden Hour ◽

Poor Outcome ◽

Multivariable Logistic Regression ◽

Scale Scores ◽

The Impact

Background: Previous studies have demonstrated the importance keeping thrombectomy procedure times ≤60 min., termed the ‘golden hour’. In the current study, we further investigate the significance of the ‘golden hour’ and the impact of procedural timing on clinical outcomes after mechanical thrombectomy. Methods: We performed an analysis of 319 consecutive mechanical thrombectomy patients at a single Comprehensive Stroke Center from April 2012 through February 2019. Bivariate analyses compared patients grouped according to procedure time ≤60 min. or >60 min. and time of stroke onset-to-endovascular therapy (OTE) ≤6 hours or >6 hours. Logistic regression was used to determine independent predictors of poor outcome at 90-days defined by modified Rankin Scale (mRS) scores of 3-6. Results: A procedure time ≤60 min. was associated with increased revascularization rates (88% vs. 67%; p<0.001) and a greater percentage of good outcomes at 90-days (47% vs. 31%; p=0.003). Multivariable logistic regression revealed that greater age (OR 1.03, 95% CI 1.004-1.051; p=0.023), higher admission NIHSS score (OR 1.10, 95% CI 1.038-1.159; p=0.001), and history of diabetes mellitus (OR 1.94, 95% CI 1.049-3.580; p=0.035) were independently associated with a greater odds of poor outcome. Modified TICI scale scores of 2C (OR 0.12, 95% CI 0.047-0.313; p<0.001) and 3 (OR 0.19, 95% CI 0.079-0.445; p<0.001) were associated with a reduced odds of poor outcome. Although not statistically significant on univariate analysis, OTE ≤6 hrs. was independently associated with a reduced odds of poor outcome (OR 0.41, 95% CI 0.212-0.809; p=0.010) in the final multivariate model (AUC 0.800). Procedure time ≤60 min. did not have a significant independent association with clinical outcome on multivariate analysis (p=0.095). Conclusions: Thrombectomy procedure times beyond 60 min. are associated with lower overall revascularization rates and worse 90 day functional outcomes when compared to faster thrombectomy procedures. However, thrombectomy procedure time was not predictive of outcome on multivariable logistic regression analysis. Our study emphasizes the significance of achieving revascularization despite the requisite procedure time.

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