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Outcomes of endovascular treatment for acute large-vessel ischaemic stroke more than 6 h after symptom onset.

Abstract：

BACKGROUND AND OBJECTIVES:Benefit from endovascular thrombectomy (EVT) for large-vessel occlusion (LVO) acute ischaemic stroke (AIS) is well demonstrated. Furthermore, emerging evidence supports efficacy in appropriately selected patients treated beyond current recommendations of 6 h. We evaluated clinical outcomes in patients undergoing late EVT at our institution. METHODS:Retrospective review of prospectively collected clinical database on 355 patients who underwent EVT for LVO AIS. Data collected consisted of patient demographics, radiological findings and outcome details. Outcomes, including 90-day functional status, recanalization, symptomatic intracranial haemorrhage (sICH) and 90-day mortality, for patients undergoing EVT <6 h, >6 h, and >7.3 h, were compared. RESULTS:A total of 355 patients underwent EVT for LVO AIS at our institution during the review period, with 74 (21%) patients treated ≥6 h from symptom onset. Successful recanalization was achieved in 285 (80%) patients, with 228 (81%) achieving a mTICI ≥2b in the <6 h group, and 57 (77%) in the >6 h group (P = 0.429). Ninety-day functional independence (mRS 0-2) was achieved in 162 (46%) patients, with 130 (46%) achieving a mRS of 0-2 in the <6 h group, and 32 (43%) in the >6 h group (P = 0.643). No significant differences were found in rates of sICH or 90-day mortality. No significant differences in functional independence, recanalization rates, sICH or mortality were identified in patients treated with EVT >7.3 h compared to <7.3 h. CONCLUSIONS:In appropriately selected patients, EVT >6 h was associated with comparable outcomes to those treated <6 h. These data support a physiological approach to patient selection.

journal_name

J Intern Med

journal_title

Journal of internal medicine

authors

Motyer R,Kok HK,Asadi H,O'Hare A,Brennan P,Power S,Looby S,Nicholson P,Williams D,Murphy S,Hill MD,Goyal M,McManus J,O'Brien P,Thornton J

doi

10.1111/joim.12680

subject

Has Abstract

pub_date

2017-12-01 00:00:00

pages

537-545

issue

eissn

0954-6820

issn

1365-2796

journal_volume

282

pub_type

杂志文章,多中心研究

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Outcomes of endovascular treatment for acute large-vessel ischaemic stroke more than 6 h after symptom onset.