Telma Santos 1 , Andreia Carvalho 1 , André Almeida Cunha 2 , Marta Rodrigues 2 , Tiago Gregório 3 , Ludovina Paredes 3 , Henrique Costa 1,3 , José Mário Roriz 4 , João Pinho 5 , Miguel Veloso 1,3 , Sérgio Castro 2 , Pedro Barros 1,3 , Manuel Ribeiro 2 Show Affiliations »
Abstract
INTRODUCTION: Recently, the benefit of selecting patients for endovascular treatment (EVT) beyond the 6-hour time window using a tissue-based approach was demonstrated in two randomized trials. The optimal imaging protocol for selecting patients is under debate, and it is still unknown if a simpler and faster protocol may adequately select patients with wake-up stroke (WUS) and late-presenting stroke (LPS) for EVT. OBJECTIVE: To compare outcomes of patients submitted to EVT presenting within 6 hours of symptom onset or 6-24 hours after last seen well, selected using non-contrast computed tomography (NCCT) and CT angiography (CTA). METHODS: An observational study was performed, which included consecutive patients with anterior circulation ischemic stroke with large vessel occlusion treated with EVT. Patients presenting within 6 hours were treated if their NIH Stroke Scale (NIHSS) score was ≥6 and Alberta Stroke Program Early CT score (ASPECTS) was ≥6, while patients presenting with WUS or 6-24 hours after last seen well (WUS/LPS) were treated if their NIHSSscore was ≥12 and ASPECTS was ≥7. RESULTS: 249 patients were included, 63 of whom were in the WUS/LPS group. Baseline characteristics were similar between groups, except for longer symptom-recanalization time, lower admission NIHSS (16 vs 17, P=0.038), more frequent tandem occlusions (25.4% vs 11.8%, P=0.010), and large artery atherosclerosis etiology (22.2% vs 11.8%, P=0.043) in the WUS/LPS group. No differences in symptomatic intracranial hemorrhage, peri-procedural complications or mortality were found between groups. Three-month functional independence was similar in both groups (65.1% in WUS/LPS vs 57.0% in ≤6 hours, P=0.259) and no differences were found after adjustment for confounders. CONCLUSIONS: This real-world observational study suggests that EVT may be safe and effective in patients with WUS and LPS selected using clinical-core mismatch (high NIHSS/high ASPECTS in NCCT). © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
INTRODUCTION: Recently, the benefit of selecting patients for endovascular treatment (EVT ) beyond the 6-hour time window using a tissue-based approach was demonstrated in two randomized trials. The optimal imaging protocol for selecting patients is under debate, and it is still unknown if a simpler and faster protocol may adequately select patients with wake-up stroke (WUS ) and late-presenting stroke (LPS ) for EVT . OBJECTIVE: To compare outcomes of patients submitted to EVT presenting within 6 hours of symptom onset or 6-24 hours after last seen well, selected using non-contrast computed tomography (NCCT) and CT angiography (CTA). METHODS: An observational study was performed, which included consecutive patients with anterior circulation ischemic stroke with large vessel occlusion treated with EVT . Patients presenting within 6 hours were treated if their NIH Stroke Scale (NIHSS ) score was ≥6 and Alberta Stroke Program Early CT score (ASPECTS) was ≥6, while patients presenting with WUS or 6-24 hours after last seen well (WUS /LPS ) were treated if their NIHSSscore was ≥12 and ASPECTS was ≥7. RESULTS: 249 patients were included, 63 of whom were in the WUS /LPS group. Baseline characteristics were similar between groups, except for longer symptom-recanalization time, lower admission NIHSS (16 vs 17, P=0.038), more frequent tandem occlusions (25.4% vs 11.8%, P=0.010), and large artery atherosclerosis etiology (22.2% vs 11.8%, P=0.043) in the WUS /LPS group. No differences in symptomatic intracranial hemorrhage , peri-procedural complications or mortality were found between groups. Three-month functional independence was similar in both groups (65.1% in WUS /LPS vs 57.0% in ≤6 hours, P=0.259) and no differences were found after adjustment for confounders. CONCLUSIONS: This real-world observational study suggests that EVT may be safe and effective in patients with WUS and LPS selected using clinical-core mismatch (high NIHSS /high ASPECTS in NCCT). © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Entities: Chemical
Disease
Species
Keywords:
intervention; stroke; thrombectomy
Mesh： See more »
Year: 2018
PMID： 30097484 DOI： 10.1136/neurintsurg-2018-014051
Source DB: PubMed Journal: J Neurointerv Surg ISSN： 1759-8478 Impact factor: 5.836