Procedure time and outcomes in acute ischemic stroke with anterior circulation large vessel occlusion in the early and late time windows: A stratified analysis by onset-to-puncture time

Previous studies have suggested that procedure time (PT) is associated with prognosis in patients undergoing endovascular treatment (EVT). However, its relationship with prognosis in different time windows remains unclear. This study aimed to investigate the relationship between PT and outcomes in patients with EVT in early (<6 ​h) versus late-window (6-24 ​h) window. In this prospective cohort database, we analyzed consecutive patients undergoing EVT. We assessed the association between PT and 90-day modified Rankin Scale scores (primary outcome) using multivariable ordinal logistic regression, stratified by onset to arterial puncture time (OPT) (<6 ​h vs. 6-24 ​h), and adjusted for key confounders. This study included 788 patients, of whom 221 (28.1 ​%) were female. The median age was 63 years (IQR 54-70), and the median NIHSS score was 13 (IQR 10-16). In the early-window group, longer PT was associated with worse functional outcomes (adjusted common odds ratio [acOR] per 10 ​min, 1.11; 95 ​% CI, 1.06-1.16) and higher mortality (adjusted odds ratio [aOR] per 10 ​min, 1.09; 95 ​% CI, 1.02-1.18). Conversely, in the late-window group, there was no significant association between PT and functional outcome (acOR per 10 ​min, 1.04; 95 ​% CI, 0.99-1.09) or mortality (aOR per 10 ​min, 1.05; 95 ​% CI, 0.96-1.14). In this real-world study, for patients with AIS due to LVO within 6 ​h of onset, longer PT was associated with worse prognosis and higher mortality. However, for patients with an onset time of 6-24 ​h, the impact of PT on patient outcomes was not significant.