Comparison of time to treatment between intravenous and endovascular thrombolytic treatments for acute ischemic stroke

Background: Intravenous (IV) recombinant tissue plasminogen activator (rt-PA) is used to treat acute ischemic stroke (AIS) within 4.5 hours of symptom onset. Endovascular treatment (ET) may provide higher rates of recanalization, but longer time to treatment may limit comparative clinical benefit and widespread applicability.

Objective: This retrospective study compares symptom onset to treatment times in patients who received both IV rt-PA and ET for AIS and its effect on clinical outcome.

Methods: AIS patients presenting to our facility who received both IV rt-PA and ET were reviewed using them as case and control to match other factors contributing to time to treatment. Good outcome was defined as modified Rankin Scale score 0 to 2 at discharge.

Results: Fifty patients received both treatments with significantly shorter mean symptom onset to time to IV rt-PA compared with symptom onset to time to ET (96.8 ± 39.3 minutes versus 255.3 ± 92.2 minutes, p < 0.001). Patients receiving ET in less time than the mean time had a higher rate of favorable outcome at discharge (45.5% versus 11.8%, p = 0.017) and a significantly lower rate of mortality at three months (15.2% versus 52.9%, p = 0.017) than those receiving it after the mean time. The symptom onset to times to ET was significantly longer in transferred patients compared to primary emergency department patients (299.3 minutes versus 230.5 minutes, p = 0.01)

Conclusion: A considerable difference in symptom onset to treatment times between IV and ET was observed among patients with AIS, especially those who were transferred from another facility. Reducing the time to treatment for ET has the potential to improve outcomes among ischemic stroke patients.