Purpose Newer generations of devices in endovascular therapies are progressively used in the revascularization of large vessel occlusions in acute ischemic stroke. The aim of this case review study was to evaluate if there was a corresponding improvement in procedural times over the course of the evolution of these devices.
Methods Procedural times from 6 prospective and retrospective endovascular treatment trials were pooled for analysis: the Pivotal, PICS, START, POST, RetroSTART, and SPEED 054 trials. All trials had the Penumbra Aspiration System as the primary therapy while patients that obtained treatment >8 h from stroke onset were excluded from the analysis. The outcomes of interest were 90 day mRS and time of revascularization (total aspiration time).
The univariate relationships between the outcomes and predictor variables were calculated using Spearman’s rank correlation for continuous variables and Wilcoxon rank sums for two-group variables. Predictors of 90 day mRS with a univariate significance of p < 0.20 were included in the multivariate model. The final multivariate logistic regression model of 90 day mRS (0–2) was determined using a standard stepwise selection method. The level of significance was set at p < 0.05.
Results Out of the 1028 pooled subjects, 932 met the study criteria for analysis. The mean age was 66+15 years; 51% were female. The median admission NIHSS was 18 (IQR 13–21) and all patients had a score of TIMI 0–1 prior to endovascular treatment. The primary vessel locations were 22% ICA, 73% MCA and 5% were in other locations. Post endovascular treatment 84% achieved revascularization to TIMI 2–3. The mean time from stroke onset to hospital presentation was 2.1 h and groin access was obtained 4.4 h after stroke onset.
In the univariate analysis, shorter aspiration times were associated with female gender, revascularization to TIMI 2–3, use of larger catheters, later hospital presentation and later procedure years. A lower 90 day mRS score (better outcome) was also associated with shorter aspiration time (r = 0.11, p = 0.0044) as well as shorter procedure time, younger age, female gender, lower baseline NIHSS, and revascularization to TIMI 2–3.
Taking into consideration the patient’s age, baseline NIHSS, and post treatment revascularization status in the multivariate model, the aspiration time remained a significant predictor of outcome at 90 days post procedure (p = 0.003). The odds of a poor outcome were greater as the aspiration time increased.
Conclusion In this pooled cohort, the evolution of the newer and larger Penumbra catheters provides a faster and more efficient method for treating acute ischemic stroke associated with better functional outcomes.
Disclosures D. Frei: 2; C; Penumbra, Inc.. 4; C; Penumbra, Inc.. R. Gupta: None. R. Bellon: None. D. Huddle: None. G. Dooley: None. H. Buell: 5; C; Penumbra, Inc. K. Adamski: 5; C; Penumbra, Inc. A. Patel: 5; C; Penumbra, Inc. S. Kuo: 5; C; Penumbra, Inc. S. Hak: 5; C; Penumbra, Inc. A. Bose: 4; C; Penumbra, Inc. 5; C; Penumbra, Inc. S. Sit: 4; C; Penumbra, Inc. 5; C; Penumbra, Inc.