Tissue Clock Beyond Time Clock: Endovascular Thrombectomy for Patients With Large Vessel Occlusion Stroke Beyond 24 Hours.

IF 6 1区医学 Q1 CLINICAL NEUROLOGY Journal of Stroke Pub Date : 2023-05-01 DOI:10.5853/jos.2023.00017

Ghada A Mohamed, Raul G Nogueira, Muhammed Amir Essibayi, Hassan Aboul-Nour, Mahmoud Mohammaden, Diogo C Haussen, Aldo Mendez Ruiz, Bradley A Gross, Okkes Kuybu, Mohamed M Salem, Jan-Karl Burkhardt, Brian Jankowitz, James E Siegler, Pratit Patel, Taryn Hester, Santiago Ortega-Gutierrez, Mudassir Farooqui, Milagros Galecio-Castillo, Thanh N Nguyen, Mohamad Abdalkader, Piers Klein, Jude H Charles, Vasu Saini, Dileep R Yavagal, Ammar Jumah, Ali Alaraj, Sophia Peng, Muhammad Hafeez, Omar Tanweer, Peter Kan, Jacopo Scaggiante, Stavros Matsoukas, Johanna T Fifi, Stephan A Mayer, Alex B Chebl

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引用次数: 3

Abstract

Background and purpose: Randomized trials proved the benefits of mechanical thrombectomy (MT) for select patients with large vessel occlusion (LVO) within 24 hours of last-known-well (LKW). Recent data suggest that LVO patients may benefit from MT beyond 24 hours. This study reports the safety and outcomes of MT beyond 24 hours of LKW compared to standard medical therapy (SMT).

Methods: This is a retrospective analysis of LVO patients presented to 11 comprehensive stroke centers in the United States beyond 24 hours from LKW between January 2015 and December 2021. We assessed 90-day outcomes using the modified Rankin Scale (mRS).

Results: Of 334 patients presented with LVO beyond 24 hours, 64% received MT and 36% received SMT only. Patients who received MT were older (67±15 vs. 64±15 years, P=0.047) and had a higher baseline National Institutes of Health Stroke Scale (NIHSS; 16±7 vs.10±9, P<0.001). Successful recanalization (modified thrombolysis in cerebral infarction score 2b-3) was achieved in 83%, and 5.6% had symptomatic intracranial hemorrhage compared to 2.5% in the SMT group (P=0.19). MT was associated with mRS 0-2 at 90 days (adjusted odds ratio [aOR] 5.73, P=0.026), less mortality (34% vs. 63%, P<0.001), and better discharge NIHSS (P<0.001) compared to SMT in patients with baseline NIHSS ≥6. This treatment benefit remained after matching both groups. Age (aOR 0.94, P<0.001), baseline NIHSS (aOR 0.91, P=0.017), Alberta Stroke Program Early Computed Tomography (ASPECTS) score ≥8 (aOR 3.06, P=0.041), and collaterals scores (aOR 1.41, P=0.027) were associated with 90-day functional independence.

Conclusion: In patients with salvageable brain tissue, MT for LVO beyond 24 hours appears to improve outcomes compared to SMT, especially in patients with severe strokes. Patients' age, ASPECTS, collaterals, and baseline NIHSS score should be considered before discounting MT merely based on LKW.

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组织时钟超越时间时钟:大血管闭塞卒中患者血管内血栓切除术超过24小时。

背景和目的:随机试验证明了机械取栓(MT)对大血管闭塞(LVO)患者在最后已知(LKW) 24小时内的益处。最近的数据表明，LVO患者可能受益于24小时以上的MT。本研究报告了与标准药物治疗(SMT)相比，MT治疗LKW超过24小时的安全性和结果。方法:回顾性分析2015年1月至2021年12月期间，从LKW到美国11个综合卒中中心24小时以上的LVO患者。我们使用改良Rankin量表(mRS)评估90天的预后。结果:334例LVO超过24小时的患者中，64%接受MT治疗，36%仅接受SMT治疗。接受MT治疗的患者年龄较大(67±15岁vs 64±15岁，P=0.047)，基线美国国立卫生研究院卒中量表(NIHSS;结论:与SMT相比，在可修复脑组织的患者中，24小时以上的LVO MT似乎改善了预后，特别是在严重卒中患者中。在仅根据LKW对MT进行折扣之前，应考虑患者的年龄、各方面、侧边和基线NIHSS评分。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Stroke CLINICAL NEUROLOGYPERIPHERAL VASCULAR DISE-PERIPHERAL VASCULAR DISEASE

CiteScore

11.00

自引率

3.70%

发文量

审稿时长

12 weeks

期刊介绍： The Journal of Stroke (JoS) is a peer-reviewed publication that focuses on clinical and basic investigation of cerebral circulation and associated diseases in stroke-related fields. Its aim is to enhance patient management, education, clinical or experimental research, and professionalism. The journal covers various areas of stroke research, including pathophysiology, risk factors, symptomatology, imaging, treatment, and rehabilitation. Basic science research is included when it provides clinically relevant information. The JoS is particularly interested in studies that highlight characteristics of stroke in the Asian population, as they are underrepresented in the literature. The JoS had an impact factor of 8.2 in 2022 and aims to provide high-quality research papers to readers while maintaining a strong reputation. It is published three times a year, on the last day of January, May, and September. The online version of the journal is considered the main version as it includes all available content. Supplementary issues are occasionally published. The journal is indexed in various databases, including SCI(E), Pubmed, PubMed Central, Scopus, KoreaMed, Komci, Synapse, Science Central, Google Scholar, and DOI/Crossref. It is also the official journal of the Korean Stroke Society since 1999, with the abbreviated title J Stroke.