LAUSR

Introduction: Timely recanalization is strongly associated with functional independence in patients who undergo mechanical thrombectomy (MT) for a large vessel occlusion (LVO). The American Heart Association recommends Door to Recanalization/Reperfusion (DTRp) time of ≤120 minutes. We aim to identify factors associated with a delayed DTRp at a comprehensive stroke center (CSS). Methods: We performed a retrospective chart review of patients who underwent MT for an anterior circulation LVO at a CSS from 7/2014 to 12/2020. We compared various presenting variables and technical parameters between patients who achieved DTRp in ≤120 minutes vs. ≥120 minutes. A binary logistic regression analysis was performed, controlling for age, sex, NIHSS, presenting mean arterial pressure (MAP), presenting serum calcium level, Hb A1C, LDL, intravenous alteplase, left hemispheric location, location of the clot (internal carotid artery vs. middle cerebral artery), ≥50% ipsilateral stenosis, ASPECTS≥6, general anesthesia, transradial approach, number of passes, arrival to the emergency department on night shift (7 pm to 7 am) and on weekends. Results: 217 patients met our inclusion criteria. The mean age was 64.09±14.4 years. In our cohort, arrival on weekend (66.84% vs. 4.76%; OR, 0.02; 95% CI,0.01-0.37; P 0.012), higher serum calcium level (9.02±0.62mg/dL vs. 8.4±0.9mg/dL; OR, 6.7; 95% CI,1.77-25.31; P 0.005), left hemispheric occlusion (52.55% vs.14.29%; OR, 0.05; 95% CI,0.01-0.33; P 0.002), general anesthesia (81.67% vs.61.90%; OR, 0.16; 95% CI,0.03-0.81; P 0.026), higher presenting MAP (105.33±21.05 vs.91.93±10.79; OR, 1.1; 95% CI,1.03-1.17; P 0.004) and female sex (47.96% vs.33.33%; OR, 5.61; 95% CI,1.09-28.87; P 0.039) were associated with DTRp of ≥120 minutes. Conclusion: Parameters of arrival on the weekend, higher serum calcium level, higher MAP, left hemispheric occlusion, use of general anesthesia, and female sex were associated with DTRp of ≥120 minutes.