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Success with incrementally faster times to endovascular therapy (SWIFT-EVT): A systematic review and meta-analysis
Journal article   Open access   Peer reviewed

Success with incrementally faster times to endovascular therapy (SWIFT-EVT): A systematic review and meta-analysis

Brittney Legere, Ahmed Mohamed, Salah Elsherif, Razan Saqqur, David Schoenfeld, Anna M. Slebonick, Michael McCartin, James Price, Kori S. Zachrison, Jonathan A. Edlow, …
Journal of stroke and cerebrovascular diseases, v 33(11), 107964
01 Nov 2024
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2024.107964
PMID: 39182706
url
https://doi.org/10.1016/j.jstrokecerebrovasdis.2024.107964View
Published, Version of Record (VoR) Open

Abstract

Emergency medical services Endovascular therapy Helicopter transport Treatment time Stroke
A major systematic review and meta-analysis assessing trial data through 2014 (the Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials, HERMES) demonstrated that particularly over the initial six hours of acute ischemic stroke (AIS), rapid performance of endovascular therapy (EVT) markedly improves outcomes. The current analysis, Success with Incrementally Faster Times to EVT (SWIFT-EVT), aimed to provide an updated metric summarizing latest estimates for modified Rankin Scale (mRS) improvements accrued by streamlining time to EVT. A systematic review and meta-analysis was conducted using electronic databases. Eligible studies reported a time-benefit slope with times from AIS onset (or time last known normal) to EVT commencement; the predictor was onset-to-groin (OTG) time. Primary and secondary outcomes were 90-day functional independence (mRS 0-2) and 90-day excellent function (mRS 0-1), respectively. Five studies were included. Results showed increased change of good outcome with each hour of pre-EVT time savings for mRS 0-2 for 0-270’ (OR 1.25, 95 % CI 1.16-1.35, I2 40 %) and 271-360’ time frame (1.22, 95 % CI 1.12-1.33, I2 58 %). For the studies assessing mRS 0-1, estimates were found appropriate for both the 0-270’ time frame (OR 1.34, 95 % CI 1.19-1.51, I2 27 %) and the 271-360’ time frame (OR 1.20, 95 % CI 1.03-1.38, I2 60 %). Each hour saved from AIS onset to EVT start is associated with a 22-25 % increased odds of achieving functional independence, a useful metric to inform patient-specific and systems planning decisions.

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