# Association between door-to-needle time and outcomes in acute ischemic stroke patients treated with intravenous thrombolysis plus mechanical thrombectomy: Analysis from the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS)

## TL;DR

Shorter door-to-needle times improve outcomes for stroke patients treated with clot-dissolving drugs and mechanical removal of the clot.

## Contribution

This study demonstrates that shorter door-to-needle times are linked to better functional and safety outcomes in acute stroke patients.

## Key findings

- A door-to-needle time of ≤60 minutes was associated with better 3-month functional independence and lower intracranial hemorrhage rates.
- Shorter door-to-needle times (≤30, ≤45, ≤60 minutes) were linked to higher successful reperfusion and reduced 3-month mortality.
- Door-to-needle time ≤60 minutes significantly reduced the risk of any intracranial hemorrhage and 3-month mortality.

## Abstract

We aim to evaluate the association between door-to-needle time (DTN) and outcomes in a population of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) + mechanical thrombectomy (MT) in the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS).

Patients with AIS secondary to middle cerebral artery or intracranial internal carotid artery occlusion with known times of symptoms onset, directly presenting to an MT-capable center, were included in the analysis. According to pre-defined DTN cut-off values (⩽30, ⩽45, and ⩽60 min), we evaluated the association between DTN and outcomes by multivariate logistic regression analyses. Effectiveness outcomes were 3-month functional independence, 3-month excellent outcome and successful reperfusion. Safety outcomes were any intracranial hemorrhage (ICH), symptomatic intracerebral hemorrhage (sICH), and 3-month mortality.

About 1602 patients were included in our analysis. After logistic regression analysis, a DTN ⩽ 60 min was significantly associated with 3-month functional independence (OR 1.36; 95% CI 1.02–1.82). DTNs ⩽ 30, ⩽45, and ⩽60 min were significantly associated with successful reperfusion (OR 2.66; 95% CI 1.6–4.43; OR 1.68; 95%CI 1.25-2.26; OR 1.57; 95% CI 1.21–2.05; respectively). A DTN ⩽ 60 min was also significantly associated with lower rate of any ICH (OR 0.61; 95% CI 0.43–0.86). DTNs ⩽ 30, ⩽45, and ⩽60 min were significantly associated with lower 3-month mortality (OR 0.24; 95% CI 0.08–0.67; OR 0.45; 95% CI 0.29–0.72; OR 0.58; 95% CI 0.39–0.84; respectively).

In patients with AIS treated with IVT + MT, a shorter DTN is associated with better outcomes if IVT is initiated within 1 h of hospital admission.

Graphical abstract