Ilaria Casetta1, Enrico Fainardi2, Valentina Saia3, Giovanni Pracucci4, Marina Padroni1, Leonardo Renieri5, Patrizia Nencini4, Domenico Inzitari4, Daniele Morosetti6, Fabrizio Sallustio7, Stefano Vallone8, Guido Bigliardi9, Andrea Zini10, Marcello Longo11, Isabella Francalanza12, Sandra Bracco13, Ignazio M Vallone13, Rossana Tassi14, Mauro Bergui15, Andrea Naldi16, Andrea Saletti17, Alessandro De Vito18, Roberto Gasparotti19, Mauro Magoni, Lucio Castellan20, Carlo Serrati21, Roberto Menozzi22, Umberto Scoditti23, Francesco Causin24, Alessio Pieroni25, Edoardo Puglielli26, Alfonsina Casalena27, Antioco Sanna28, Maria Ruggiero28, Francesco Cordici29, Luca Di Maggio30, Enrica Duc31, Mirco Cosottini32, Nicola Giannini33, Giuseppina Sanfilippo34, Federico Zappoli34, Anna Cavallini, Nicola Cavasin35, Adriana Critelli36, Elisa Ciceri37, Mauro Plebani37, Manuel Cappellari38, Luigi Chiumarulo39, Marco Petruzzellis40, Alberto Terrana41, Lucia Princiotta Cariddi42, Nicola Burdi43, Angelica Tinelli44, William Auteri45, Umberto Silvagni45, Francesco Biraschi46, Ettore Nicolini47, Riccardo Padolecchia48, Tiziana Tassinari49, Pietro Filauri50, Simona Sacco51, Marco Pavia52, Paolo Invernizzi53, Nunzio P Nuzzi54, Simona Marcheselli55, Pietro Amistà56, Monia Russo57, Ivan Gallesio58, Giuseppe Craparo59, Marina Mannino60, Salvatore Mangiafico5, Danilo Toni47. 1. Clinica Neurologica, University of Ferrara, (I.C., M.P.). 2. Neuroradiology Unit, University of Florence (E.F.). 3. Stroke Unit, Santa Corona Hospital, Pietra Ligure (V.S.). 4. Stroke Unit, Careggi University Hospital, Florence (G.P., P.N., D.I.). 5. Interventional Neuroradiology Unit, Careggi University Hospital, Florence (L.R., S.M.). 6. Diagnostic Imaging and Interventional Radiology Unit (D.M.), University of Rome Tor Vergata. 7. Stroke Unit (F.S.), University of Rome Tor Vergata. 8. Interventional Neuroradiology Unit (S.V.), Ospedale Civile "S.Agostino-Estense", AOU Modena. 9. Stroke Unit (G.B.), Ospedale Civile "S.Agostino-Estense", AOU Modena. 10. Neurology and Stroke Unit, Maggiore Hospital, Bologna (A.Z.). 11. Interventional Neuroradiology Unit, Policlinico G Martino, Messina (M.L.). 12. Stroke Unit, Policlinico G. Martino, Messina (F.I.). 13. Neuroimaging and Neurointervention Unit (NINT), AOU Senese, Siena (S.B., I.M.V.). 14. Stroke Unit, University Hospital "S. Maria delle Scotte", Siena (R.T.). 15. Interventional Neuroradiology Unit, Città della Salute e della Scienza-Molinette, Turin (M.B.). 16. Department of Neuroscience "Rita Levi Montalcini", University of Turin (A.N.). 17. Interventional Neuroradiology Unit, University Hospital "Arcispedale S. Anna", Ferrara (A.S.). 18. Stroke Unit, University Hospital "Arcispedale S. Anna", Ferrara (A.D.V.). 19. Interventional Neuroradiology Unit, "Spedali Civili", Brescia (R.G.). 20. Interventional Neuroradiology Unit, IRCCS San Martino-IST, Genova (L.C.). 21. Neurology and Stroke Unit, IRCCS San Martino-IST, Genova (C.S.). 22. Interventional Neuroradiology Unit (R.M.), University Hospital, Parma. 23. Stroke Unit (U.S.), University Hospital, Parma. 24. Neuroradiology Unit (F.C.), Padua University Hospital. 25. Stroke Unit and Neurosonology Lab (A.P.), Padua University Hospital. 26. Vascular and Interventional Radiology Unit (E.P.), Ospedale Civile "Mazzini", Teramo. 27. Neurology Unit (A.C.), Ospedale Civile "Mazzini", Teramo. 28. Neuroradiology Unit (A.S., M.R.), "M. Bufalini" Hospital-AUSL Romagna, Cesena. 29. Neurology Unit (F.C.). "M. Bufalini" Hospital-AUSL Romagna, Cesena. 30. Interventional Radiology and Neuroradiology Unit (L.D.M), San Giovanni Bosco Hospital, Torino. 31. Neurology Unit (E.D.), San Giovanni Bosco Hospital, Torino. 32. Neuroradiology Unit (M.C.), AOU Pisa. 33. Neurology Unit (G.N.), AOU Pisa. 34. Radiology, Diagnostic and Interventional Neuroradiology Unit, Policlinico IRCCS San Matteo, Pavia (G.S., F.Z.). 35. Neuroradiology Unit (N.C.), Ospedale dell'Angelo-USSL3 Serenissima, Mestre. 36. Neurology Unit (A.C.), Ospedale dell'Angelo-USSL3 Serenissima, Mestre. 37. Neuroradiology Unit (E.C., M.P.), AOUI Verona. 38. Neurology Unit (M.C.), AOUI Verona. 39. Interventional Neuroradiology Unit (L.C.), Policlinico Bari. 40. Stroke Unit (M.P.), Policlinico Bari. 41. Neuroradiology Unit (A.T.), AOU Circolo, ASST-Settelaghi, Varese. 42. Neurology and Stroke Unit (L.P.C.), AOU Circolo, ASST-Settelaghi, Varese. 43. Interventional Radiology (N.B.), Ospedale SS. Annunziata, Taranto. 44. Stroke Unit (A.T.), Ospedale SS. Annunziata, Taranto. 45. Interventional Neuroradiology Unit, AO Annunziata, Cosenza (W.A., U.S.). 46. Interventional Neuroradiology Unit, Policlinico Umberto I, Rome (F.B.). 47. Emergency Department Stroke Unit, Sapienza University Hospital, Rome (E.N., D.T.). 48. Neuroradiology Unit (R.P.), S. Corona Hospital-ASL2 Savonese, Pietra Ligure. 49. Neurology and Stroke Unit (T.T.), S. Corona Hospital-ASL2 Savonese, Pietra Ligure. 50. Interventional Neuroradiology Unit, PO SS. Filippo e Nicola, Avezzano (P.F.). 51. Department of Applied Clinical Sciences e Biotechnology, University of L'Aquila, L'Aquila (S.S.). 52. Neuroradiology Unit (M.P.), Istituto Ospedaliero Fondazione Poliambulanza, Brescia. 53. Neurology Unit (P.I.), Istituto Ospedaliero Fondazione Poliambulanza, Brescia. 54. Interventional Neuroradiology Unit (N.P.N.), Humanitas Research Hospital, Rozzano. 55. Urgent Neurology and Stroke Unit (S.M.), Humanitas Research Hospital, Rozzano. 56. Interventional Neuroradiology Unit (P.A.), S. Maria della Misericordia Hospital, Rovigo. 57. Stroke Unit (M.R.), S. Maria della Misericordia Hospital, Rovigo. 58. Neuroradiology Unit, SS. Antonio e Biagio e C. Arrigo Hospital, Alessandria (I.G.). 59. Interventional Neuroradiology Unit (G.C.), Ospedale Civico-A.R.N.A.S., Palermo. 60. Stroke Unit (M.M.), Ospedale Civico-A.R.N.A.S., Palermo.
Abstract
BACKGROUND AND PURPOSE: To evaluate outcome and safety of endovascular treatment beyond 6 hours of onset of ischemic stroke due to large vessel occlusion in the anterior circulation, in routine clinical practice. METHODS: From the Italian Registry of Endovascular Thrombectomy, we extracted clinical and outcome data of patients treated for stroke of known onset beyond 6 hours. Additional inclusion criteria were prestroke modified Rankin Scale score ≤2 and ASPECTS score ≥6. Patients were selected on individual basis by a combination of CT perfusion mismatch (difference between total hypoperfusion and infarct core sizes) and CT collateral score. The primary outcome measure was the score on modified Rankin Scale at 90 days. Safety outcomes were 90-day mortality and the occurrence of symptomatic intracranial hemorrhage. Data were compared with those from patients treated within 6 hours. RESULTS: Out of 3057 patients, 327 were treated beyond 6 hours. Their mean age was 66.8±14.9 years, the median baseline National Institutes of Health Stroke Scale 16, and the median onset to groin puncture time 430 minutes. The most frequent site of occlusion was middle cerebral artery (45.1%). Functional independence (90-day modified Rankin Scale score, 0-2) was achieved by 41.3% of cases. Symptomatic intracranial hemorrhage occurred in 6.7% of patients, and 3-month case fatality rate was 17.1%. The probability of surviving with modified Rankin Scale score, 0-2 (odds ratio, 0.58 [95% CI, 0.43-0.77]) was significantly lower in patients treated beyond 6 hours as compared with patients treated earlier No differences were found regarding recanalization rates and safety outcomes between patients treated within and beyond 6 hours. There were no differences in outcome between people treated 6-12 hours from onset (278 patients) and those treated 12 to 24 hours from onset (49 patients). CONCLUSIONS: This real-world study suggests that in patients with large vessel occlusion selected on the basis of CT perfusion and collateral circulation assessment, endovascular treatment beyond 6 hours is feasible and safe with no increase in symptomatic intracranial hemorrhage.
BACKGROUND AND PURPOSE: To evaluate outcome and safety of endovascular treatment beyond 6 hours of onset of ischemic stroke due to large vessel occlusion in the anterior circulation, in routine clinical practice. METHODS: From the Italian Registry of Endovascular Thrombectomy, we extracted clinical and outcome data of patients treated for stroke of known onset beyond 6 hours. Additional inclusion criteria were prestroke modified Rankin Scale score ≤2 and ASPECTS score ≥6. Patients were selected on individual basis by a combination of CT perfusion mismatch (difference between total hypoperfusion and infarct core sizes) and CT collateral score. The primary outcome measure was the score on modified Rankin Scale at 90 days. Safety outcomes were 90-day mortality and the occurrence of symptomatic intracranial hemorrhage. Data were compared with those from patients treated within 6 hours. RESULTS: Out of 3057 patients, 327 were treated beyond 6 hours. Their mean age was 66.8±14.9 years, the median baseline National Institutes of Health Stroke Scale 16, and the median onset to groin puncture time 430 minutes. The most frequent site of occlusion was middle cerebral artery (45.1%). Functional independence (90-day modified Rankin Scale score, 0-2) was achieved by 41.3% of cases. Symptomatic intracranial hemorrhage occurred in 6.7% of patients, and 3-month case fatality rate was 17.1%. The probability of surviving with modified Rankin Scale score, 0-2 (odds ratio, 0.58 [95% CI, 0.43-0.77]) was significantly lower in patients treated beyond 6 hours as compared with patients treated earlier No differences were found regarding recanalization rates and safety outcomes between patients treated within and beyond 6 hours. There were no differences in outcome between people treated 6-12 hours from onset (278 patients) and those treated 12 to 24 hours from onset (49 patients). CONCLUSIONS: This real-world study suggests that in patients with large vessel occlusion selected on the basis of CT perfusion and collateral circulation assessment, endovascular treatment beyond 6 hours is feasible and safe with no increase in symptomatic intracranial hemorrhage.
Authors: Ilaria Casetta; Enrico Fainardi; Giovanni Pracucci; Valentina Saia; Fabrizio Sallustio; Valerio da Ros; Sergio Nappini; Patrizia Nencini; Guido Bigliardi; Sergio Vinci; Francesco Grillo; Sandra Bracco; Rossana Tassi; Mauro Bergui; Paolo Cerrato; Andrea Saletti; Alessandro De Vito; Roberto Gasparotti; Mauro Magoni; Luigi Simonetti; Andrea Zini; Maria Ruggiero; Marco Longoni; Lucio Castellan; Laura Malfatto; Paola Castellini; Mirco Cosottini; Alessio Comai; Enrica Franchini; Emilio Lozupone; Giacomo Della Marca; Edoardo Puglielli; Alfonsina Casalena; Claudio Baracchini; Daniele Savio; Enrica Duc; Giuseppe Ricciardi; Manuel Cappellari; Luigi Chiumarulo; Marco Petruzzellis; Anna Cavallini; Nicola Cavasin; Adriana Critelli; Nicola Burdi; Giovanni Boero; Andrea Giorgianni; Maurizio Versino; Francesco Biraschi; Ettore Nicolini; Simone Comelli; Maurizio Melis; Riccardo Padolecchia; Tiziana Tassinari; Nunzio Paolo Nuzzi; Simona Marcheselli; Simona Sacco; Paolo Invernizzi; Ivan Gallesio; Delfina Ferrandi; Maria Fancello; Maria Valeria Saddi; Monia Russo; Aldo Pischedda; Antonio Baule; Marina Mannino; Francesco Florio; Vincenzo Inchingolo; Maria Elena Flacco; Daniele Romano; Umberto Silvagni; Domenico Inzitari; Salvatore Mangiafico; Danilo Toni Journal: Eur Stroke J Date: 2022-04-07
Authors: Ankur Verma; Shivani Sarda; Sanjay Jaiswal; Amit Batra; Meghna Haldar; Wasil R Sheikh; Amit Vishen; Palak Khanna; Rinkey Ahuja; Abbas A Khatai Journal: Indian J Crit Care Med Date: 2022-05
Authors: Jan C Purrucker; Peter A Ringleb; Fatih Seker; Arne Potreck; Simon Nagel; Silvia Schönenberger; Anne Berberich; Ulf Neuberger; Markus Möhlenbruch; Charlotte Weyland Journal: Ther Adv Neurol Disord Date: 2022-05-25 Impact factor: 6.430