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Journal of Neurology
Published in: Journal of Neurology 10/2020

01-10-2020 | Stroke | Original Communication

Mechanical thrombectomy for ischaemic stroke in the anterior circulation: off-hours effect

Authors: Olfa Kaaouana, Nicolas Bricout, Barbara Casolla, François Caparros, Lucie Della Schiava, François Mounier-Vehier, Marco Pasi, Nelly Dequatre-Ponchelle, Jean-Pierre Pruvo, Charlotte Cordonnier, Hilde Hénon, Didier Leys

Published in: Journal of Neurology | Issue 10/2020

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Abstract

Background

Patients treated at off-hours for acute conditions have increased mortality rates. This effect has been poorly evaluated in patients treated by mechanical thrombectomy (MT).

Objective

This study aimed at comparing outcomes between patients treated at off-hours and at working hours by MT for acute stroke due to large-vessel occlusion in the anterior circulation, in a well-organised network.

Method

We included consecutive adults who underwent MT for large-vessel occlusion in the anterior circulation over a 51-month period, in the network of 16 hospitals from the North-of-France area, sharing similar protocols. Patients underwent magnetic resonance imaging-scans at admission and then 22–36 h later. We compared 3-month outcomes of patients treated at off-hours and at working time, the primary outcome being a modified Rankin scale (mRS) 0 to 2.

Results

The study population consisted of 1,179 patients (631 women, 53.5%; mean age 72 years; median baseline National Institutes of Stroke Scale 17; 639 at off-hours, 54.2%; 734 treated with rt-PA, 62.3%; median delay stroke recognition to end of MT 281 min). No patient was lost to follow-up. The outcomes did not differ between the two groups: adjusted odds ratio (adjOR) for mRS 0–2: 0.89; 95% confidence interval (CI) 0.67–1.18; adjOR for mRS 0–1: 0.91; 95% CI 0.68–1.21; adjOR for death 1.12; 95% CI 0.81–1.55).

Conclusion

Our study did not show worse outcomes in patients treated at off-hours. This result suggests that the off-hours effect reported in other studies can be minimized by a coordinated organisation of stroke care providing similar levels of care at off-hours.
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Metadata
Title
Mechanical thrombectomy for ischaemic stroke in the anterior circulation: off-hours effect
Authors
Olfa Kaaouana
Nicolas Bricout
Barbara Casolla
François Caparros
Lucie Della Schiava
François Mounier-Vehier
Marco Pasi
Nelly Dequatre-Ponchelle
Jean-Pierre Pruvo
Charlotte Cordonnier
Hilde Hénon
Didier Leys
Publication date
01-10-2020
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue 10/2020
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-020-09946-6

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