Success with incrementally faster times to endovascular therapy (SWIFT-EVT): A systematic review and meta-analysis

Brittney Legere; Ahmed Mohamed; Salah Elsherif; Razan Saqqur; David Schoenfeld; Anna M Slebonick; Michael McCartin; James Price; Kori S Zachrison; Jonathan A Edlow; Maher Saqqur; Ashfaq Shuaib; Stephen H Thomas

doi:10.1016/j.jstrokecerebrovasdis.2024.107964

Success with incrementally faster times to endovascular therapy (SWIFT-EVT): A systematic review and meta-analysis

J Stroke Cerebrovasc Dis. 2024 Nov;33(11):107964. doi: 10.1016/j.jstrokecerebrovasdis.2024.107964. Epub 2024 Aug 23.

Authors

Affiliations

¹ Department of Applied Human Sciences, University of Guelph, Guelph, Ontario, Canada. Electronic address: [email protected].
² Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada. Electronic address: [email protected].
³ Department of Health Sciences, Queens University, Kingston, Ontario, Canada. Electronic address: [email protected].
⁴ Department of Health, University of Waterloo, Waterloo, Ontario, Canada. Electronic address: [email protected].
⁵ Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA. Electronic address: [email protected].
⁶ Drexel University School of Medicine, Philadelphia, PA, USA. Electronic address: [email protected].
⁷ Section of Emergency Medicine, University of Chicago, Chicago, IL, USA. Electronic address: [email protected].
⁸ Department of Emergency Medicine, Cambridge University NHS Trust, Cambridge, UK. Electronic address: [email protected].
⁹ Department of Emergency Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA. Electronic address: [email protected].
¹⁰ Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA. Electronic address: [email protected].
¹¹ Department of Neurology, University of Toronto, Mississauga, ON, Canada. Electronic address: [email protected].
¹² Department of Neurology, University of Alberta, Edmonton, AB, Canada. Electronic address: [email protected].
¹³ Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA; Blizard Institute for Neuroscience, Surgery, & Trauma, Barts & The London School of Medicine, London, UK. Electronic address: [email protected].

PMID: 39182706
DOI: 10.1016/j.jstrokecerebrovasdis.2024.107964

Abstract

Background: A major systematic review and meta-analysis assessing trial data through 2014 (the Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials, HERMES) demonstrated that particularly over the initial six hours of acute ischemic stroke (AIS), rapid performance of endovascular therapy (EVT) markedly improves outcomes. The current analysis, Success with Incrementally Faster Times to EVT (SWIFT-EVT), aimed to provide an updated metric summarizing latest estimates for modified Rankin Scale (mRS) improvements accrued by streamlining time to EVT.

Methods: A systematic review and meta-analysis was conducted using electronic databases. Eligible studies reported a time-benefit slope with times from AIS onset (or time last known normal) to EVT commencement; the predictor was onset-to-groin (OTG) time. Primary and secondary outcomes were 90-day functional independence (mRS 0-2) and 90-day excellent function (mRS 0-1), respectively.

Results: Five studies were included. Results showed increased change of good outcome with each hour of pre-EVT time savings for mRS 0-2 for 0-270' (OR 1.25, 95 % CI 1.16-1.35, I² 40 %) and 271-360' time frame (1.22, 95 % CI 1.12-1.33, I² 58 %). For the studies assessing mRS 0-1, estimates were found appropriate for both the 0-270' time frame (OR 1.34, 95 % CI 1.19-1.51, I² 27 %) and the 271-360' time frame (OR 1.20, 95 % CI 1.03-1.38, I² 60 %).

Conclusions: Each hour saved from AIS onset to EVT start is associated with a 22-25 % increased odds of achieving functional independence, a useful metric to inform patient-specific and systems planning decisions.

Keywords: Emergency medical services; Endovascular therapy; Helicopter transport; Stroke; Treatment time.

Publication types

Systematic Review
Meta-Analysis

MeSH terms

Aged
Disability Evaluation*
Endovascular Procedures* / adverse effects
Female
Functional Status*
Humans
Ischemic Stroke* / diagnosis
Ischemic Stroke* / physiopathology
Ischemic Stroke* / therapy
Male
Middle Aged
Recovery of Function*
Risk Factors
Time Factors
Time-to-Treatment*
Treatment Outcome

Grants and funding

U24 NS107233/NS/NINDS NIH HHS/United States