Thrombectomy 6-24 hours after stroke in trial ineligible patients

被引：65

作者：

Desai, Shashvat M. ^{[1
]}

Rocha, Marcelo ^{[1
]}

Molyneaux, Bradley J. ^{[1
]}

Starr, Matthew ^{[1
]}

Kenmuir, Cynthia L. ^{[1
]}

Gross, Bradley A. ^{[2
]}

Jankowitz, Brian Thomas ^{[2
]}

Jovin, Tudor G. ^{[1
,2
]}

Jadhav, Ashutosh P. ^{[1
,2
]}

机构：

[1] Univ Pittsburgh, Med Ctr, Dept Neurol, Pittsburgh, PA USA

[2] Univ Pittsburgh, Dept Neurosurg, Pittsburgh, PA USA

来源：

JOURNAL OF NEUROINTERVENTIONAL SURGERY | 2018年 / 10卷 / 11期

关键词：

thrombectomy; stroke; intervention; ACUTE ISCHEMIC-STROKE; HEALTH-CARE PROFESSIONALS; ENDOVASCULAR TREATMENT; MECHANICAL THROMBECTOMY; EARLY MANAGEMENT; GUIDELINES; UPDATE;

D O I：

10.1136/neurintsurg-2018-013915

中图分类号：

R445 [影像诊断学];

学科分类号：

100231 [临床病理学];

摘要：

Background and purpose The DAWN and DEFUSE-3 trials demonstrated the benefit of endovascular thrombectomy (ET) in late-presenting acute ischemic strokes due to anterior circulation large vessel occlusion (ACLVO). Strict criteria were employed for patient selection. We sought to evaluate the characteristics and outcomes of patients treated outside these trials. Methods A retrospective review of acute ischemic stroke admissions to a single comprehensive stroke center was performed during the DAWN trial enrollment period (November 2014 to February 2017) to identify all patients presenting in the 6-24hour time window. These patients were further investigated for trial eligibility, baseline characteristics, treatment, and outcomes. Results Approximately 70% (n=142) of the 204 patients presenting 6-24hours after last known well with NIH Stroke Scale score 6and harboring an ACLVO are DAWN and/or DEFUSE-3 ineligible, most commonly due to large infarct burden (38%). 26% (n=37) of trial ineligible patients with large vessel occlusion strokes received off-label ET and 30% of them achieved functional independence (modified Rankin Scale 0-2) at 90 days. Rates of symptomatic intracranial hemorrhage and mortality were 8% and 24%, respectively Conclusion Trial ineligible patients with large vessel occlusion strokes receiving off-label ET achieved outcomes comparable to DAWN and DEFUSE-3 eligible patients. Patients aged <80 years are most likely to benefit from ET in this subgroup. These data indicate a larger population of patients who can potentially benefit from ET in the expanded time window if more permissive criteria are applied.

引用

页码：1033 / 1037

页数：6

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