DWI ASPECTS Can Detect Patients Who Require Puncture to Recanalization within 30 minutes for Large Vessel Occlusion

AbstractsO_ST_ABSBACKGROUNDC_ST_ABSFaster recanalization for acute large vessel occlusion is associated with better clinical outcome. The aim of this study was to identify patient characteristics that require puncture-to-recanalization (P-R) time within 30 min for good clinical outcome. METHODSWe evaluated the patients from K-NET Registry, which is a prospective, multicenter, observational registry of acute ischemic stroke patients. The present analysis included patients who met the following criteria: (1) treated with endovascular therapy for ICA or MCA M1 occlusion; and (2) achieved successful recanalization (mTICI 2b or more). Patients were divided into subgroups according to pre-treatment patients characteristics; DWI ASPECTS, age, NIHSS, occlusion site and symptom recognition to puncture time. In each subgroup, the frequency of good clinical outcomes was compared between P-R time <30min and >30min. We entered interaction terms into the models to evaluate the correlation between each patient characteristic and P-R time. RESULTS1053 patients were included in this study. Overall, P-R <30min was significantly associated with good outcome. Univariate analysis in each subgroup revealed a significant association between P-R <30min and good outcomes in the patients with DWI ASPECTS [&le;]6, age >85 and NIHSS [&ge;]16. In multivariable analysis, NIHSS, age, symptom recognition to puncture time, DWI ASPECTS and P-R <30 minutes were significant independent predictors of good outcomes; however, only DWI ASPECTS had interaction terms with P-R <30 minutes. Multivariable analysis showed P-R <30min was an independent predictor for good outcome in patients with DWI ASPECTS [&le;]6, whereas P-R<30min was not in patients with DWI [&ge;]7. CONCLUSIONSP-R<30 min is a predictor of good clinical outcome, however, the effect depends on DWI ASPECTS. A target P-R time of less than 30 minutes is appropriate for patients with DWI ASPECTS scores of 0-6, whereas 30 minutes or longer is reasonable for patients with DWI ASPECTS 7 or higher.