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. 2020 Nov 25:neurintsurg-2020-016902.
doi: 10.1136/neurintsurg-2020-016902. Online ahead of print.

Imaging criteria across pivotal randomized controlled trials for late window thrombectomy patient selection

Bijoy K Menon  1   2 , Johanna Maria Ospel  1   3 , Ryan A McTaggart  4 , Raul G Nogueira  5 , Andrew M Demchuk  1   2 , Alexandre Poppe  6 , Jeremy L Rempel  7 , Charlotte Zerna  2 , Manish Joshi  8 , Mohammed A Almekhlafi  1   2 , Thalia S Field  9 , Dariush Dowlatshahi  10 , Brian Anthony van Adel  11 , Eric Sauvageau  12 , Jason Tarpley  13 , Tiago Moreira  14 , Oh Young Bang  15 , Don Heck  16 , Marios N Psychogios  3 , Michael Tymianski  17 , Michael D Hill  1   2 , Mayank Goyal  18   2   8 ; ESCAPE-NA1 investigators
Affiliations

Imaging criteria across pivotal randomized controlled trials for late window thrombectomy patient selection

Bijoy K Menon et al. J Neurointerv Surg. .

Abstract

Background: The DAWN and DEFUSE-3 trials showed the benefit of endovascular treatment (EVT) in acute ischemic stroke patients presenting beyond 6 hours from last known well (LKW) and selected by perfusion imaging criteria. The ESCAPE NA1-trial selected patients based on non-contrast CT (NCCT) Alberta Stroke Program Early CT Score (ASPECTS) and multiphase CT angiography (CTA) collateral status. This study compares baseline characteristics, workflow, and outcomes in the EVT arms of DAWN and DEFUSE-3 with late-window patients from the EVT-only arm of ESCAPE-NA1.

Methods: Aggregate data on baseline characteristics, workflow, reperfusion quality, final infarct volume, and clinical outcomes (modified Rankin Score [mRS] at 90 days) in subjects enrolled in the DAWN and DEFUSE-3 EVT arms were compared with similar data from the ESCAPE-NA1 control arm (EVT-only arm) presenting beyond 6 hours from LKW using descriptive statistics.

Results: Baseline characteristics among late-window patients in the ESCAPE NA1 trial were similar to those in the DAWN and DEFUSE-3 EVT arms. Median time from LKW-to-puncture in subjects enrolled in the ESCAPE NA1 trial was 9 hrs (IQR: 7.5-11 hours) when compared with DAWN (n=107; 12.8 hours, IQR: 10.6-16.7 hours) and DEFUSE-3 (n=92; 11.5 hours, IQR: 9.2-12.8 hours). Median post-treatment infarct-volume was largest in the ESCAPE NA1-patients (47 mL [IQR: 19-146] vs median 8 mL [IQR: 0-48] in the DAWN group and 35 mL [IQR: 18-82] in DEFUSE-3), while % mRS 0-2 at 90 days were similar across the three trials (ESCAPE NA1: 50/111 [45%], DAWN: 52/107 [49%], DEFUSE-3: 41/92 [45%]).

Conclusion: Patients enrolled beyond 6 hours from LKW in the ESCAPE-NA1 trial based on NCCT-ASPECTS and mCTA had similar clinical outcomes when compared with patients selected by perfusion imaging in the DAWN and DEFUSE-3 trials.

Keywords: CT; CT angiography; CT perfusion; stroke.

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Conflict of interest statement

Competing interests: BM holds a patent on systems of triage in acute stroke and stock ownership in Circle Neurovascular Inc. MG is a consultant for Medtronic, Stryker, Microvention, GE Healthcare, and Mentice. MH reports grants from CIHR during the conduct of the study, grants from Medtronic, and grants from NoNO Inc. outside the submitted work. In addition, he has a patent to US Patent office Number: 62/086,077 issued and licensed, and Director, Board of Circle Neurovascular, Director, Board of the Canadian Neuroscience Federation, and Director, Board of the Canadian Stroke Consortium.

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