TY - JOUR
T1 - Endovascular treatment in anterior circulation stroke beyond 6.5 hours after onset or time last seen well: results from the MR CLEAN Registry
AU - Dekker, L.
AU - Venema, E.
AU - Pirson, F.A.V.
AU - Majoie, C.B.L.M.
AU - Emmer, B.J.
AU - Jansen, I.G.H.
AU - Mulder, M.J.H.L.
AU - Lemmens, R.
AU - Wermer, M.J.H.
AU - Boiten, J.
AU - Nijeholt, G.J.L.A.
AU - Roos, Y.B.W.E.M.
AU - van Es, A.C.G.M.
AU - Lingsma, H.F.
AU - Dippel, D.W.J.
AU - van Zwam, W.H.
AU - van den Wijngaard, I.R.
AU - MR CLEAN Registry Investigators
N1 - Funding Information:
Funding The MR CLEAN Registry was partly funded by TWIN Foundation, Erasmus MC University Medical Center, Maastricht University Medical Center and Academic Medical Center Amsterdam. No funding was obtained for this specific substudy. Robin Lemmens is a senior clinical investigator of FWO Flanders.
Funding Information:
5Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands 6Neurology, University Hospitals Leuven, Leuven, Belgium 7Neurosciences, Experimental Neurology and Leuven Brain Institute, University of Leuven, Leuven, Belgium 8VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium 9Neurology, Haaglanden Medical Centre, Den Haag, The Netherlands 10Radiology, Haaglanden Medical Centre, Den Haag, The Netherlands 11Neurology, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands 12Radiology, Leiden University Medical Centre, Leiden, The Netherlands 13Radiology, Maastricht University Medical Centre+, Maastricht, The Netherlands Acknowledgements We acknowledge the support of the Netherlands Cardiovascular Research Initiative which is supported by the Dutch Heart Foundation, CVON2015-01: CONTRAST, and the support of the Brain Foundation Netherlands (HA2015.01.06).
Publisher Copyright:
©
PY - 2021/12
Y1 - 2021/12
N2 - Background Randomised controlled trials with perfusion selection have shown benefit of endovascular treatment (EVT) for ischaemic stroke between 6 and 24 hours after symptom onset or time last seen well. However, outcomes after EVT in these late window patients without perfusion imaging are largely unknown. We assessed their characteristics and outcomes in routine clinical practice. Methods The Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry, a prospective, multicentre study in the Netherlands, included patients with an anterior circulation occlusion who underwent EVT between 2014 and 2017. CT perfusion was no standard imaging modality. We used adjusted ordinal logistic regression analysis to compare patients treated within versus beyond 6.5 hours after propensity score matching on age, prestroke modified Rankin Scale (mRS), National Institutes of Health Stroke Scale, Alberta Stroke Programme Early CT Score (ASPECTS), collateral status, location of occlusion and treatment with intravenous thrombolysis. Outcomes included 3-month mRS score, functional independence (defined as mRS 0-2), and death. Results Of 3264 patients who underwent EVT, 106 (3.2%) were treated beyond 6.5 hours (median 8.5, IQR 6.9-10.6), of whom 93 (87.7%) had unknown time of stroke onset. CT perfusion was not performed in 87/106 (80.2%) late window patients. Late window patients were younger (mean 67 vs 70 years, p<0.04) and had slightly lower ASPECTS (median 8 vs 9, p<0.01), but better collateral status (collateral score 2-3: 68.3% vs 57.7%, p=0.03). No differences were observed in proportions of functional independence (43.3% vs 40.5%, p=0.57) or death (24.0% vs 28.9%, p=0.28). After matching, outcomes remained similar (adjusted common OR for 1 point improvement in mRS 1.04, 95% CI 0.56 to 1.93). Conclusions Without the use of CT perfusion selection criteria, EVT in the 6.5-24-hour time window was not associated with poorer outcome in selected patients with favourable clinical and CT/CT angiography characteristics. randomised controlled trials with lenient inclusion criteria are needed to identify more patients who can benefit from EVT in the late window.
AB - Background Randomised controlled trials with perfusion selection have shown benefit of endovascular treatment (EVT) for ischaemic stroke between 6 and 24 hours after symptom onset or time last seen well. However, outcomes after EVT in these late window patients without perfusion imaging are largely unknown. We assessed their characteristics and outcomes in routine clinical practice. Methods The Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry, a prospective, multicentre study in the Netherlands, included patients with an anterior circulation occlusion who underwent EVT between 2014 and 2017. CT perfusion was no standard imaging modality. We used adjusted ordinal logistic regression analysis to compare patients treated within versus beyond 6.5 hours after propensity score matching on age, prestroke modified Rankin Scale (mRS), National Institutes of Health Stroke Scale, Alberta Stroke Programme Early CT Score (ASPECTS), collateral status, location of occlusion and treatment with intravenous thrombolysis. Outcomes included 3-month mRS score, functional independence (defined as mRS 0-2), and death. Results Of 3264 patients who underwent EVT, 106 (3.2%) were treated beyond 6.5 hours (median 8.5, IQR 6.9-10.6), of whom 93 (87.7%) had unknown time of stroke onset. CT perfusion was not performed in 87/106 (80.2%) late window patients. Late window patients were younger (mean 67 vs 70 years, p<0.04) and had slightly lower ASPECTS (median 8 vs 9, p<0.01), but better collateral status (collateral score 2-3: 68.3% vs 57.7%, p=0.03). No differences were observed in proportions of functional independence (43.3% vs 40.5%, p=0.57) or death (24.0% vs 28.9%, p=0.28). After matching, outcomes remained similar (adjusted common OR for 1 point improvement in mRS 1.04, 95% CI 0.56 to 1.93). Conclusions Without the use of CT perfusion selection criteria, EVT in the 6.5-24-hour time window was not associated with poorer outcome in selected patients with favourable clinical and CT/CT angiography characteristics. randomised controlled trials with lenient inclusion criteria are needed to identify more patients who can benefit from EVT in the late window.
KW - Thrombectomy
KW - Stroke
KW - ACUTE ISCHEMIC-STROKE
KW - HEALTH-CARE PROFESSIONALS
KW - EARLY MANAGEMENT
KW - CT ANGIOGRAPHY
KW - THROMBECTOMY
KW - OUTCOMES
KW - GUIDELINES
KW - INFARCTION
KW - SCORE
U2 - 10.1136/svn-2020-000803
DO - 10.1136/svn-2020-000803
M3 - Article
C2 - 33827915
SN - 2059-8688
VL - 6
SP - 572
EP - 580
JO - Stroke and Vascular Neurology
JF - Stroke and Vascular Neurology
IS - 4
ER -