Endovascular treatment in anterior circulation stroke beyond 6.5 hours after onset or time last seen well: results from the MR CLEAN Registry

Stroke and Vascular Neurology

article

Luuk Dekker¹  Esmee Venema²  F Anne V Pirson⁴  Charles B L M Majoie⁵  Bart J Emmer⁵  Ivo G H Jansen⁵  Maxim J H L Mulder²  Robin Lemmens⁶  Robert-Jan B Goldhoorn⁴  Marieke J H Wermer¹  Jelis Boiten⁹  Geert J Lycklama à Nijeholt^1,10  Yvo B W E M Roos^1,11  Adriaan C G M van Es^1,10  Hester F Lingsma³  Diederik W J Dippel²  Wim H van Zwam^1,13  Robert J van Oostenbrugge⁴  Ido R van den Wijngaard¹ 

[1] Neurology , Leiden University Medical Centre;Neurology;Public Health;Neurology , Maastricht University Medical Centre+;Radiology and Nuclear Medicine , Amsterdam University Medical Centre;Neurology , University Hospitals Leuven;Neurosciences, Experimental Neurology and Leuven Brain Institute , University of Leuven;VIB, Center for Brain & Disease Research, Laboratory of Neurobiology;Neurology , Haaglanden Medical Centre;Radiology , Haaglanden Medical Centre;Neurology , Amsterdam University Medical Centre;Radiology , Leiden University Medical Centre;Radiology , Maastricht University Medical Centre+

关键词: Thrombectomy;    Stroke;   

DOI  :  10.1136/svn-2020-000803

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

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.

【 授权许可】

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