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. 2020 May;30(3):315-320.
doi: 10.1111/jon.12698. Epub 2020 Feb 18.

Mechanical Thrombectomy for Acute Stroke: Early versus Late Time Window Outcomes

Chantal Bhan  1   2 , Tracy J Koehler  3 , Lee Elisevich  4 , Justin Singer  2   5 , Paul Mazaris  2   4 , Elysia James  1   2 , Joseph Zachariah  1   2 , Jordan Combs  1   2 , Michelle Dejesus  1   2 , Tricia Tubergen  6 , Laurel Packard  1 , Jiangyong Min  1   2 , Nabil Wees  1   2 , Nadeem Khan  1   2 , Todd Mulderink  7   8   9 , Muhib Khan  1   2
Affiliations
Free article

Mechanical Thrombectomy for Acute Stroke: Early versus Late Time Window Outcomes

Chantal Bhan et al. J Neuroimaging. 2020 May.
Free article

Abstract

Background and purpose: Recent trials have shown benefit of thrombectomy in patients selected by penumbral imaging in the late (>6 hours) window. However, the role penumbral imaging is not clear in the early (0-6 hours) window. We sought to evaluate if time to treatment modifies the effect of endovascular reperfusion in stroke patients with evidence of salvageable tissue on CT perfusion (CTP).

Methods: We retrospectively analyzed consecutive patients who underwent thrombectomy in a single center. Demographics, comorbidities, National Institute of Health Stroke Scale (NIHSS), rtPA administration, ASPECTS, core infarct volume, onset to skin puncture time, recanalization (mTICI IIb/III), final infarct volume were compared between patients with good and poor 90-day outcomes (mRS 0-2 vs. 3-6). Multivariable logistic regression analyses were used to identify independent predictors of a good (mRS 0-2) 90-day outcome.

Results: A total of 235 patients were studied, out of which 52.3% were female. Univariate analysis showed that the groups (early vs. late) were balanced for age (P = .23), NIHSS (P = .63), vessel occlusion location (P = .78), initial core infarct volume (P = .15), and recanalization (mTICI IIb/III) rates (P = .22). Favorable outcome (mRS 0-2) at 90 days (P = .30) were similar. There was a significant difference in final infarct volume (P = .04). Shift analysis did not reveal any significant difference in 90-day outcome (P = .14). After adjustment; age (P < .001), NIHSS (P = .01), recanalization (P = .008), and final infarct volume (P < .001) were predictive of favorable outcome.

Conclusions: Penumbral imaging-based selection of patients for thrombectomy is effective regardless of onset time and yields similar functional outcomes in early and late window patients.

Keywords: Computed tomography; core infarct; magnetic resonance imaging; perfusion.

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References

    1. Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016;387:1723-31.
    1. Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018;378:11-21.
    1. Albers GW, Marks MP, Kemp S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018;378:708-18.
    1. Albers GW, Marks MP, Lansberg MG. Thrombectomy for stroke with selection by perfusion imaging. N Engl J Med 2018;378:1849-50.
    1. Campbell BC, Parsons MW. Imaging selection for acute stroke intervention. Int J Stroke 2018;13:554-67.

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