Puncture-to-Reperfusion Time Threshold Guides Procedural Termination in Thrombectomy: Analysis from the ANGEL-ACT Registry

Purpose The role of puncture-to-reperfusion time (PRT) remains under investigation. Our study aimed to explore whether it could serve as an indicator for procedural termination. Methods Patients who underwent endovascular therapy within 6 hours of onset due to anterior large-vessel occlusion were selected from ANGEL-ACT. Restricted cubic splines (RCS) with 3 knots defined PRT thresholds. Outcomes were compared successful reperfusion with prolonged PRT (PRT > 51 min) and partial reperfusion groups. Potential subgroups who might benefit from prolonged PRT were compared. Primary outcome was 90-day mRS, safety outcomes were mortality at 90days, any intracranial hemorrhage and symptomatic intracranial hemorrhage. Results 51 minutes was determined as PRT cutoff in our study. Those achieved successful reperfusion with prolonged PRT had higher mRS 0–3 rate compared with those achieved partial reperfusion (aOR 2.86 [95% CI 1.21–6.76], P = 0.02); No significant differences were found in other outcomes. Subgroup analysis indicated similar result in patients aged < 65 years, while no significant difference in primary outcome was observed in intravenous thrombolysis subgroup and ASPECTS ≥ 8 subgroup. Conclusion Our findings suggest that prolonged PRT improves outcomes, particularly in patients < 65 years, but not in patients received intravenous thrombolysis or ASPECTS ≥ 8. Individualized termination protocols are needed, pending further validation.