Impact of time from symptom onset to puncture, and puncture to reperfusion, in endovascular therapy in the late time window (>6 hours).

IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY International Journal of Stroke Pub Date : 2024-11-05 DOI:10.1177/17474930241300073
Agathe Sadeler, Stephanos Finitsis, Jean-Marc Olivot, Sebastien Richard, Gaultier Marnat, Igor Sibon, Lionel Calviere, Christophe Cognard, Mikael Mazighi, Jean-Philippe Desilles, Bertrand Lapergue, Ruben Tamazyan, Mathieu Zuber, Benjamin Gory, Benjamin Maier
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Abstract

Background- Increased times from symptom onset to puncture (TSOP) and from puncture to reperfusion (TPTR) are associated with worse outcome in ischemic stroke patients treated with endovascular therapy (EVT) in the early time window (<6 hours). However, these associations are less described in the late window (>6 hours), where patients may benefit from EVT because of a more favorable imaging profile (late window paradox). We sought to compare the effect of these timeframes between these two periods on efficacy and safety outcomes.Methods- The ETIS Registry (Endovascular Treatment in Ischemic Stroke) is an ongoing, prospective, observational study in 21 centers that perform EVT in France. We included adult patients with an anterior occlusion, successfully treated by EVT (mTICI 2b-3) between January 2015 and June 2023, with a known time of stroke onset. The cohort was divided into 2 groups according to the TSOP (≤6h vs >6h). Primary outcome was favorable outcome (modified Rankin Scale 0-2 at 90 days).Results- 7,516 patients were included, with 5,936 patients being treated ≤6h and 1,580 >6h. In the early window, TSOP and TPTR were associated with worse outcomes at 90 days (adjusted OR=0.68 per hour; 95%CI, 0.64-0.73; p<0.001 and aOR=0.92 per 10 minutes increment; 95%CI, 0.90-0.94, p<0.001, respectively). TSOP was not associated with worse outcomes at 90 days in the late window (p=0.955), but TPTR was associated with worse outcomes (aOR=0.91 per 10 minutes increment; 95%CI, 0.86-0.96, p=0.001), every 10 additional minutes in TPTR being associated with a 1.7% (95%CI, 0.6%-2.7%) decreased probability of favorable outcome.Conclusions- Only EVT procedural time is associated to unfavorable outcomes at 90 days in late window patients. These results highlight how the late window paradox may end at the start of EVT and underscore the need for timely management, particularly for the EVT, even for late window patients with a presumed more favorable imaging profile.

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晚期时间窗(>6 小时)内的血管内治疗中,从症状出现到穿刺的时间以及从穿刺到再灌注的时间的影响。
背景-缺血性卒中患者从症状出现到穿刺(TSOP)和从穿刺到再灌注(TPTR)的时间延长与早期时间窗(6小时)内接受血管内治疗(EVT)的患者预后较差有关,在早期时间窗内接受EVT治疗的患者可能因更有利的影像学特征而受益(晚期时间窗悖论)。我们试图比较这两个时间段对疗效和安全性结果的影响。方法--ETIS 注册(缺血性脑卒中血管内治疗)是一项正在进行的前瞻性观察研究,在法国 21 个开展 EVT 的中心进行。我们纳入了在2015年1月至2023年6月期间通过EVT(mTICI 2b-3)成功治疗的前部闭塞的成年患者,他们的卒中发病时间都是已知的。根据TSOP(≤6小时 vs >6小时)将患者分为两组。结果 - 共纳入 7516 名患者,其中 5936 名患者接受了≤6 小时的治疗,1580 名患者接受了>6 小时的治疗。在早期窗口期,TSOP 和 TPTR 与 90 天后较差的预后相关(调整后 OR=0.68/h; 95%CI, 0.64-0.73; p
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来源期刊
International Journal of Stroke
International Journal of Stroke 医学-外周血管病
CiteScore
13.90
自引率
6.00%
发文量
132
审稿时长
6-12 weeks
期刊介绍: The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
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