The golden 35min of stroke intervention with ADAPT: effect of thrombectomy procedural time in acute ischemic stroke on outcome

Introduction In acute ischemic stroke (AIS), extending mechanical thrombectomy procedural times beyond 60min has previously been associated with an increased complication rate and poorer outcomes. Objective After improvements in thrombectomy methods, to reassess whether this relationship holds true with a more contemporary thrombectomy approach: a direct aspiration first pass technique (ADAPT). Methods We retrospectively studied a database of patients with AIS who underwent ADAPT thrombectomy for large vessel occlusions. Patients were dichotomized into two groups: early recan', in which recanalization (recan) was achieved in 35min, and late recan', in which procedures extended beyond 35min. Results 197 patients (47.7% women, mean age 66.3years) were identified. We determined that after 35min, a poor outcome was more likely than a good (modified Rankin Scale (mRS) score 0-2) outcome. The baseline National Institutes of Health Stroke Scale (NIHSS) score was similar between early recan' (n=122) (14.76.9) and late recan' patients (n=75) (15.9 +/- 7.2). Among early recan' patients, recanalization was achieved in 17.8 +/- 8.8min compared with 70 +/- 39.8min in late recan' patients. The likelihood of achieving a good outcome was higher in the early recan' group (65.2%) than in the late recan' group (38.2%; p<0.001). Patients in the late recan' group had a higher likelihood of postprocedural hemorrhage, specifically parenchymal hematoma type 2, than those in the early recan' group. Logistic regression analysis showed that baseline NIHSS, recanalization time, and atrial fibrillation had a significant impact on 90-day outcomes. Conclusions Our findings suggest that extending ADAPT thrombectomy procedure times beyond 35min increases the likelihood of complications such as intracerebral hemorrhage while reducing the likelihood of a good outcome.