Off-hours effects of endovascular treatment for acute ischemic stroke: a retrospective study based on a senior stroke center_West China Medical Journal

Authors：

YANG Yujia , ZHANG Yang ,  ZHOU Muke

Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

ZHOU Muke, Email: muke.zhou@scu.edu.cn

Keywords：

Acute ischemic stroke; endovascular treatment; off-hours effect

DOI：

10.7507/1002-0179.202312234

Video：

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Objective To investigate whether there is an off-hours effect on the endovascular treatment (EVT) process for patients with acute ischemic stroke (AIS) after emergency admission to the hospital. Methods We retrospectively analyzed AIS patients who were admitted to the West China Hospital of Sichuan University on the stroke green channel between September 2019 and August 2023 and planned to perform emergency EVT. The patients were divided into working-hour and off-hour groups according to their admission time. The clinical information, door-to-puncture time (DPT), door-to-head/neck imaging time (DIT) and door-to-blood test time (DBT) of the two groups patients were compared, and subgroup analysis was conducted according to whether they arrived at the hospital at night, before and after the guideline update, and whether they were in the coronavirus disease 2019 epidemic period. Results A total of 586 AIS patients with large vessel occlusion were included, including 220 patients admitted during working hours and 336 patients admitted during off-working hours. There was no statistically significant difference in the basic information and EVT process time between patients admitted during working hours and patients admitted during off-working hours (P>0.05). Subgroup analysis showed that in patients admitted during off-working hours, there was no statistically significant difference in the basic information and EVT process time between patients arrived at the hospital at night and patients did not arrive at the hospital at night (P>0.05). Before and after the guideline updated, there was no statistically significant difference in the basic information and EVT process time between patients admitted during working hours and patients admitted during off-working hours (P>0.05). No matter whether it is in the coronavirus disease 2019 epidemic period, there was no statistically significant difference in the basic information and EVT process time between patients admitted during working hours and patients admitted during off-working hours (P>0.05). Conclusions There is no off-hours effect on the EVT process time after AIS patients arrive at the hospital. In the future, more stroke centers of different levels are needed to further explore the impact of off-hours effect on emergency diagnosis and treatment of AIS patients.

Citation： YANG Yujia, ZHANG Yang, ZHOU Muke. Off-hours effects of endovascular treatment for acute ischemic stroke: a retrospective study based on a senior stroke center. West China Medical Journal, 2024, 39(5): 692-698. doi: 10.7507/1002-0179.202312234 Copy

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2.	Toyoda K, Yoshimura S, Nakai M, et al. Twenty-year change in severity and outcome of ischemic and hemorrhagic strokes. JAMA Neurol, 2022, 79(1): 61-69.
3.	Renú A, Millán M, San Román L, et al. Effect of intra-arterial alteplase vs placebo following successful thrombectomy on functional outcomes in patients with large vessel occlusion acute ischemic stroke: the CHOICE randomized clinical trial. JAMA, 2022, 327(9): 826-835.
4.	Lapergue B, Blanc R, Costalat V, et al. Effect of thrombectomy with combined contact aspiration and stent retriever vs stent retriever alone on revascularization in patients with acute ischemic stroke and large vessel occlusion: the ASTER2 randomized clinical trial. JAMA, 2021, 326(12): 1158-1169.
5.	Wassélius J, Arnberg F, von Euler M, et al. Endovascular thrombectomy for acute ischemic stroke. J Intern Med, 2022, 291(3): 303-316.
6.	Lorenzano S, Ahmed N, Tatlisumak T, et al. Within-day and weekly variations of thrombolysis in acute ischemic stroke: results from safe implementation of treatments in stroke-international stroke thrombolysis register. Stroke, 2014, 45(1): 176-184.
7.	Bray BD, Cloud GC, James MA, et al. Weekly variation in health-care quality by day and time of admission: a nationwide, registry-based, prospective cohort study of acute stroke care. Lancet, 2016, 388(10040): 170-177.
8.	Nikoubashman O, Probst T, Schürmann K, et al. Weekend effect in endovascular stroke treatment: do treatment decisions, procedural times, and outcome depend on time of admission?. J Neurointerv Surg, 2017, 9(4): 336-339.
9.	Saad A, Adil MM, Patel V, et al. Clinical outcomes after thrombectomy for acute ischemic stroke on weekends versus weekdays. J Stroke Cerebrovasc Dis, 2014, 23(10): 2708-2713.
10.	Man S, Xian Y, Holmes DN, et al. Association between thrombolytic door-to-needle time and 1-year mortality and readmission in patients with acute ischemic stroke. JAMA, 2020, 323(21): 2170-2184.
11.	Kim T, Jwa C. Impact of off-hour hospital presentation on mortality in different subtypes of acute stroke in Korea : national emergency department information system data. J Korean Neurosurg Soc, 2021, 64(1): 51-59.
12.	Grandhi R, Ravindra VM, Ney JP, et al. Investigating the “weekend effect” on outcomes of patients undergoing endovascular mechanical thrombectomy for ischemic stroke. J Stroke Cerebrovasc Dis, 2021, 30(10): 106013.
13.	Hoh BL, Chi YY, Waters MF, et al. Effect of weekend compared with weekday stroke admission on thrombolytic use, in-hospital mortality, discharge disposition, hospital charges, and length of stay in the Nationwide Inpatient Sample Database, 2002 to 2007. Stroke, 2010, 41(10): 2323-2328.
14.	Albright KC, Savitz SI, Raman R, et al. Comprehensive stroke centers and the ‘weekend effect’: the SPOTRIAS experience. Cerebrovasc Dis, 2012, 34(5/6): 424-429.
15.	中國卒中學會, 中國卒中學會神經介入分會, 中華預防醫學會卒中預防與控制專業委員會介入學組. 急性缺血性卒中血管內治療中國指南 2018. 中國卒中雜志, 2018, 13(7): 706-729.
16.	中國卒中學會, 中國卒中學會神經介入分會, 中華預防醫學會卒中預防與控制專業委員會介入學組. 急性缺血性卒中血管內治療中國指南 2023. 中國卒中雜志, 2023, 18(6): 684-711.
17.	中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組, 中華醫學會神經病學分會神經血管介入協作組. 中國急性缺血性卒中早期血管內介入診療指南 2022. 中華神經科雜志, 2022, 55(6): 565-580.
18.	Leong DP, Joseph PG, McKee M, et al. Reducing the global burden of cardiovascular disease, part 2: prevention and treatment of cardiovascular disease. Circ Res, 2017, 121(6): 695-710.
19.	Chow EJ, Uyeki TM, Chu HY. The effects of the COVID-19 pandemic on community respiratory virus activity. Nat Rev Microbiol, 2023, 21(3): 195-210.
20.	Wang J, Hong Y, Ma M, et al. Mitigating the impact of coronavirus disease 2019 on emergency stroke care: an original study and meta-analysis. Rev Neurosci, 2021, 32(4): 443-457.
21.	Tschoe C, Kittel C, Brown P, et al. Impact of off-hour endovascular therapy on outcomes for acute ischemic stroke: insights from STAR. J Neurointerv Surg, 2021, 13(8): 693-696.
22.	Benali A, Moynier M, Dargazanli C, et al. Mechanical thrombectomy in nighttime hours: is there a difference in 90-day clinical outcome for patients with ischemic stroke?. AJNR Am J Neuroradiol, 2021, 42(3): 530-537.

1. Mendelson SJ, Prabhakaran S. Diagnosis and management of transient ischemic attack and acute ischemic stroke: a review. JAMA, 2021, 325(11): 1088-1098.
2. Toyoda K, Yoshimura S, Nakai M, et al. Twenty-year change in severity and outcome of ischemic and hemorrhagic strokes. JAMA Neurol, 2022, 79(1): 61-69.
3. Renú A, Millán M, San Román L, et al. Effect of intra-arterial alteplase vs placebo following successful thrombectomy on functional outcomes in patients with large vessel occlusion acute ischemic stroke: the CHOICE randomized clinical trial. JAMA, 2022, 327(9): 826-835.
4. Lapergue B, Blanc R, Costalat V, et al. Effect of thrombectomy with combined contact aspiration and stent retriever vs stent retriever alone on revascularization in patients with acute ischemic stroke and large vessel occlusion: the ASTER2 randomized clinical trial. JAMA, 2021, 326(12): 1158-1169.
5. Wassélius J, Arnberg F, von Euler M, et al. Endovascular thrombectomy for acute ischemic stroke. J Intern Med, 2022, 291(3): 303-316.
6. Lorenzano S, Ahmed N, Tatlisumak T, et al. Within-day and weekly variations of thrombolysis in acute ischemic stroke: results from safe implementation of treatments in stroke-international stroke thrombolysis register. Stroke, 2014, 45(1): 176-184.
7. Bray BD, Cloud GC, James MA, et al. Weekly variation in health-care quality by day and time of admission: a nationwide, registry-based, prospective cohort study of acute stroke care. Lancet, 2016, 388(10040): 170-177.
8. Nikoubashman O, Probst T, Schürmann K, et al. Weekend effect in endovascular stroke treatment: do treatment decisions, procedural times, and outcome depend on time of admission?. J Neurointerv Surg, 2017, 9(4): 336-339.
9. Saad A, Adil MM, Patel V, et al. Clinical outcomes after thrombectomy for acute ischemic stroke on weekends versus weekdays. J Stroke Cerebrovasc Dis, 2014, 23(10): 2708-2713.
10. Man S, Xian Y, Holmes DN, et al. Association between thrombolytic door-to-needle time and 1-year mortality and readmission in patients with acute ischemic stroke. JAMA, 2020, 323(21): 2170-2184.
11. Kim T, Jwa C. Impact of off-hour hospital presentation on mortality in different subtypes of acute stroke in Korea : national emergency department information system data. J Korean Neurosurg Soc, 2021, 64(1): 51-59.
12. Grandhi R, Ravindra VM, Ney JP, et al. Investigating the “weekend effect” on outcomes of patients undergoing endovascular mechanical thrombectomy for ischemic stroke. J Stroke Cerebrovasc Dis, 2021, 30(10): 106013.
13. Hoh BL, Chi YY, Waters MF, et al. Effect of weekend compared with weekday stroke admission on thrombolytic use, in-hospital mortality, discharge disposition, hospital charges, and length of stay in the Nationwide Inpatient Sample Database, 2002 to 2007. Stroke, 2010, 41(10): 2323-2328.
14. Albright KC, Savitz SI, Raman R, et al. Comprehensive stroke centers and the ‘weekend effect’: the SPOTRIAS experience. Cerebrovasc Dis, 2012, 34(5/6): 424-429.
15. 中國卒中學會, 中國卒中學會神經介入分會, 中華預防醫學會卒中預防與控制專業委員會介入學組. 急性缺血性卒中血管內治療中國指南 2018. 中國卒中雜志, 2018, 13(7): 706-729.
16. 中國卒中學會, 中國卒中學會神經介入分會, 中華預防醫學會卒中預防與控制專業委員會介入學組. 急性缺血性卒中血管內治療中國指南 2023. 中國卒中雜志, 2023, 18(6): 684-711.
17. 中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組, 中華醫學會神經病學分會神經血管介入協作組. 中國急性缺血性卒中早期血管內介入診療指南 2022. 中華神經科雜志, 2022, 55(6): 565-580.
18. Leong DP, Joseph PG, McKee M, et al. Reducing the global burden of cardiovascular disease, part 2: prevention and treatment of cardiovascular disease. Circ Res, 2017, 121(6): 695-710.
19. Chow EJ, Uyeki TM, Chu HY. The effects of the COVID-19 pandemic on community respiratory virus activity. Nat Rev Microbiol, 2023, 21(3): 195-210.
20. Wang J, Hong Y, Ma M, et al. Mitigating the impact of coronavirus disease 2019 on emergency stroke care: an original study and meta-analysis. Rev Neurosci, 2021, 32(4): 443-457.
21. Tschoe C, Kittel C, Brown P, et al. Impact of off-hour endovascular therapy on outcomes for acute ischemic stroke: insights from STAR. J Neurointerv Surg, 2021, 13(8): 693-696.
22. Benali A, Moynier M, Dargazanli C, et al. Mechanical thrombectomy in nighttime hours: is there a difference in 90-day clinical outcome for patients with ischemic stroke?. AJNR Am J Neuroradiol, 2021, 42(3): 530-537.

West China Medical Journal

Off-hours effects of endovascular treatment for acute ischemic stroke: a retrospective study based on a senior stroke center

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