DWI ASPECTS Can Detect Patients Who Require Puncture to Recanalization within 30 minutes for Large Vessel Occlusion

BACKGROUND Faster recanalization for acute large vessel occlusion is associated with better clinical outcome. The aim of this study was to identify patient characteristics that require puncture-to-recanalization (P-R) time within 30 min for good clinical outcome. METHODS We evaluated the patients from K-NET Registry, which is a prospective, multicenter, observational registry of acute ischemic stroke patients. The present analysis included patients who met the following criteria: (1) treated with endovascular therapy for ICA or MCA M1 occlusion; and (2) achieved successful recanalization (mTICI 2b or more). Patients were divided into subgroups according to pre-treatment patients’ characteristics; DWI ASPECTS, age, NIHSS, occlusion site and symptom recognition to puncture time. In each subgroup, the frequency of good clinical outcomes was compared between P-R time <30min and >30min. We entered interaction terms into the models to evaluate the correlation between each patient characteristic and P-R time. RESULTS 1053 patients were included in this study. Overall, P-R <30min was significantly associated with good outcome. Univariate analysis in each subgroup revealed a significant association between P-R <30min and good outcomes in the patients with DWI ASPECTS ≤6, age >85 and NIHSS ≥16. In multivariable analysis, NIHSS, age, symptom recognition to puncture time, DWI ASPECTS and P-R <30 minutes were significant independent predictors of good outcomes; however, only DWI ASPECTS had interaction terms with P-R <30 minutes. Multivariable analysis showed P-R <30min was an independent predictor for good outcome in patients with DWI ASPECTS ≤6, whereas P-R<30min was not in patients with DWI ≥7. CONCLUSIONS P-R<30 min is a predictor of good clinical outcome, however, the effect depends on DWI ASPECTS. A target P-R time of less than 30 minutes is appropriate for patients with DWI ASPECTS scores of 0-6, whereas 30 minutes or longer is reasonable for patients with DWI ASPECTS 7 or higher. ### Competing Interest Statement Dr T.U. reports consulting fees from Kaneka Medix. Dr Y.H. reports consulting fees from Bayer Pharmaceutical and Nippon Boehringer Ingelheim. Dr M.T. reports consulting and lecture fees from Johnson and Johnson and Stryker. ### Clinical Trial NCT05213533 ### Clinical Protocols [https://journals.sagepub.com/doi/full/10.1177/17474930221138014?rfr\_dat=cr\_pub++0pubmed&url\_ver=Z39.88-2003&rfr\_id=ori%3Arid%3Acrossref.org][1] ### Funding Statement The K-NET registry was partially supported by a grant from the Japanese Society of Neuroendovascular Therapy. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Ethics Committee of St. Marianna University School of Medicine (approval no. 3757) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable We stated as follows in the methods section: The data that support the findings of this study are available from the corresponding author upon reasonable request. [1]: https://journals.sagepub.com/doi/full/10.1177/17474930221138014?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org