Endovascular stroke therapy at nighttime and on weekends-as fast and effective as during normal business hours?

Anastasios Mpotsaris; Annika Kowoll; Werner Weber; Christoph Kabbasch; Anushe Weber; Daniel Behme

Endovascular stroke therapy at nighttime and on weekends-as fast and effective as during normal business hours?

J Vasc Interv Neurol. 2015 Feb;8(1):39-45.

Authors

Anastasios Mpotsaris¹, Annika Kowoll², Werner Weber², Christoph Kabbasch³, Anushe Weber², Daniel Behme²

Affiliations

¹ Klinikum Vest, Department of Radiology and Neuroradiology, Recklinghausen, Germany ; University of Cologne, University Medical Center, Department of Radiology and Neuroradiology, Cologne, Germany.
² Ruhr-University-Bochum, University Medical Center Langendreer, Department of Radiology and Neuroradiology, Bochum, Germany ; Klinikum Vest, Department of Radiology and Neuroradiology, Recklinghausen, Germany.
³ University of Cologne, University Medical Center, Department of Radiology and Neuroradiology, Cologne, Germany.

PMID: 25825631
PMCID: PMC4367806

Abstract

Introduction: There is only limited data on the influence of the admission time (normal business hours versus nighttime and weekends) on procedural timings, revascularization efficacy, and outcome after mechanical thrombectomy. We investigated whether the admission time has an impact on the above-mentioned factors.

Methods: Our neurointerventional database was screened for all mechanical thrombectomies in anterior circulation acute ischemic stroke between 07/13 and 06/14. Outcome measures were procedural timings and clinical and demographic data; we compared patients who were admitted at normal business hours (Monday to Friday 8:00-18:00) to those admitted at night or at the weekend.

Results: 98 patients were identified. Of them, 52 (53%) were admitted during normal business hours, the remainder at night or at weekend. There was no statistically significant difference between the groups regarding the time from symptom-onset to admission, baseline National Institutes of Health Stroke Scale (NIHSS) or IVT-rate. There was a significant difference between groups for door-to-reperfusion timing, favoring patients admitted during normal business hours (146 versus 165 min, p = 0.02). Door-to-groin-puncture and groin-puncture-to-reperfusion time did not differ significantly. The rate of successful revascularizations (mTICI ≥ 2b) and the rate of favorable clinical outcome at discharge (mRS ≤ 2) did not differ between groups (77% versus 78% and 37% versus 35%, respectively).

Conclusions: There was a statistically significant prolongation of door-to-reperfusion timings for patients admitted during nighttime and weekends; it went along neither with a lower rate of successful revascularizations nor with a lower rate of favorable outcome in our series.

Abbreviations: AFatrial fibrillationAISacute ischemic strokeCTAcomputed tomography angiographyDMdiabetes mellitusENTembolization to new territoryEVTendovascular therapyHLPhyperlipoproteinemiaHTNhypertensionIQRinter-quartile rangeIVTintravenous thrombolysismRSmodified Rankin ScaleMTmechanical thrombectomyNIHSSNational Institutes of Health Stroke Scalen.s.not significantsICHsymptomatic intracranial hemorrhage.