Association of Time of Day When Endovascular Therapy for Stroke Starts and Functional Outcome

Steven D Hajdu; Johannes Kaesmacher; Patrik Michel; Gaia Sirimarco; Jean-Francois Knebel; Bruno Bartolini; Christoph C Kurmann; Francesco Puccinelli; Pascal J Mosimann; Christophe Bonvin; Marcel Arnold; Julien Niederhäuser; Ashraf Eskandari; Pasquale Mordasini; Jan Gralla; Urs Fischer; Guillaume Saliou

doi:10.1212/WNL.0000000000011449

Association of Time of Day When Endovascular Therapy for Stroke Starts and Functional Outcome

Neurology. 2021 Feb 22;96(8):e1124-e1136. doi: 10.1212/WNL.0000000000011449.

Authors

Steven D Hajdu¹, Johannes Kaesmacher², Patrik Michel², Gaia Sirimarco², Jean-Francois Knebel², Bruno Bartolini², Christoph C Kurmann², Francesco Puccinelli², Pascal J Mosimann², Christophe Bonvin², Marcel Arnold², Julien Niederhäuser², Ashraf Eskandari², Pasquale Mordasini², Jan Gralla², Urs Fischer², Guillaume Saliou²

Affiliations

¹ From the Department of Interventional and Diagnostic Radiology (S.D.H., B.B., F.P., G. Saliou), Department of Neurology (P. Michel, G. Sirimarco, A.E.), and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, Department of Clinical Neurosciences, EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) (J.-F.K.), Lausanne University Hospital, University of Lausanne; University Institute for Diagnostic, Interventional and Pediatric Radiology (J.K., C.C.K., M.A., U.F.), University Institute for Diagnostic and Interventional Neuroradiology (P.J.M., P. Mordasini, J.G.), University Hospital of Bern, University of Bern; Department of Neurology (C.B.), Sion Hospital; and Department of Neurology (J.N.), Nyon Regional Hospital, Switzerland. steven.hajdu@chuv.ch.
² From the Department of Interventional and Diagnostic Radiology (S.D.H., B.B., F.P., G. Saliou), Department of Neurology (P. Michel, G. Sirimarco, A.E.), and Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology, Department of Clinical Neurosciences, EEG Brain Mapping Core, Centre for Biomedical Imaging (CIBM) (J.-F.K.), Lausanne University Hospital, University of Lausanne; University Institute for Diagnostic, Interventional and Pediatric Radiology (J.K., C.C.K., M.A., U.F.), University Institute for Diagnostic and Interventional Neuroradiology (P.J.M., P. Mordasini, J.G.), University Hospital of Bern, University of Bern; Department of Neurology (C.B.), Sion Hospital; and Department of Neurology (J.N.), Nyon Regional Hospital, Switzerland.

Abstract

Objective: To investigate the association between endovascular therapy (EVT) start time in acute ischemic stroke (AIS) and midterm functional outcome.

Methods: This retrospective cohort study included all patients with AIS treated with EVT from 2 stroke center registries from January 2012 to December 2018. The primary outcome was the score on the modified Rankin Scale (mRS) and the utility-weighted mRS (uw-mRS) at 90 days. A proportional odds model was used to calculate the common odds ratio (OR) as a measure of the likelihood that the intervention at a given EVT start time would lead to lower scores on the mRS (shift analysis).

Results: A total of 1,558 cases were equally allotted into 12 EVT start time periods. The primary outcome favored EVT start times in the morning at 08:00-10:20 and 10:20-11:34 (OR, 0.53; 95% confidence interval [CI], 0.38 to 0.75; p < 0.001; OR, 0.62; 95% CI, 0.44 to 0.87; p = 0.006, respectively), while it disfavored EVT start times at the end of the working day at 15:55-17:15 and 18:55-20:55 (OR, 1.47; 95% CI, 1.03-2.09; p = 0.034; OR, 1.49; 95% CI, 1.03-2.15; p = 0.033). Symptom onset to EVT start time was significantly higher and use of IV tissue plasminogen activator significantly lower between 10:20 and 11:34 (p < 0.004 and p = 0.012, respectively).

Conclusion: EVT for AIS in the morning leads to better midterm functional outcome, while EVT at the end of the work day leads to poorer midterm functional outcome. Difference in baseline factors, standard workflow, and technical efficacy metrics could not be identified as potential mediators of this effect.