Association between time to treatment and functional outcomes according to the Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score in endovascular stroke therapy.

Autor: Kim JT; Department of Neurology, Chonnam National University Hospital, Gwangju, Korea., Cho BH; Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea., Choi KH; Department of Neurology, Chonnam National University Hospital, Gwangju, Korea., Park MS; Department of Neurology, Chonnam National University Hospital, Gwangju, Korea., Kim BJ; Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea., Park JM; Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea., Kang K; Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea., Lee SJ; Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Korea., Kim JG; Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Korea., Cha JK; Department of Neurology, Dong-A University Hospital, Busan, Korea., Kim DH; Department of Neurology, Dong-A University Hospital, Busan, Korea., Nah HW; Department of Neurology, Dong-A University Hospital, Busan, Korea., Park TH; Department of Neurology, Seoul Medical Center, Seoul, Korea., Park SS; Department of Neurology, Seoul Medical Center, Seoul, Korea., Lee KB; Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea., Lee J; Department of Neurology, Yeungnam University Hospital, Daegu, Korea., Hong KS; Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea., Cho YJ; Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea., Park HK; Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea., Lee BC; Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea., Yu KH; Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea., Oh MS; Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea., Kim DE; Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea., Ryu WS; Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea., Choi JC; Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea., Kwon JH; Department of Neurology, Ulsan University College of Medicine, Ulsan, Korea., Kim WJ; Department of Neurology, Ulsan University College of Medicine, Ulsan, Korea., Shin DI; Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea., Sohn SI; Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea., Hong JH; Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea., Lee JS; Department of Neurology, Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea., Lee J; Department of Neurology, Department of Biostatistics, Korea University College of Medicine, Seoul, Korea., Bae HJ; Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea., Saver JL; Department of Neurology, Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA., Cho KH; Department of Neurology, Chonnam National University Hospital, Gwangju, Korea.
Jazyk: angličtina
Zdroj: European journal of neurology [Eur J Neurol] 2020 Feb; Vol. 27 (2), pp. 343-351. Date of Electronic Publication: 2019 Oct 22.
DOI: 10.1111/ene.14083
Abstrakt: Background and Purpose: The rate at which the chance of a good outcome of endovascular stroke therapy (EVT) decays with time when eligible patients are selected by baseline diffusion-weighted magnetic resonance imaging (DWI-MRI) and whether ischaemic core size affects this rate remain to be investigated.
Methods: This study analyses a prospective multicentre registry of stroke patients treated with EVT based on pretreatment DWI-MRI that was categorized into three groups: small [Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS)] (8-10), moderate (5-7) and large (<5) cores. The main outcome was a good outcome at 90 days (modified Rankin Scale 0-2). The interaction between onset-to-groin puncture time (OTP) and DWI-ASPECTS categories regarding functional outcomes was investigated.
Results: Ultimately, 985 patients (age 69 ± 11 years; male 55%) were analysed. Potential interaction effects between the DWI-ASPECTS categories and OTP on a good outcome at 90 days were observed (P interaction  = 0.06). Every 60-min delay in OTP was associated with a 16% reduced likelihood of a good outcome at 90 days amongst patients with large cores, although no associations were observed amongst patients with small to moderate cores. Interestingly, the adjusted rates of a good outcome at 90 days steeply declined between 65 and 213 min of OTP and then remained smooth throughout 24 h of OTP (P nonlinearity  = 0.15).
Conclusions: Our study showed that the probability of a good outcome after EVT nonlinearly decreased, with a steeper decline at earlier OTP than at later OTP. Discrepant effects of OTP on functional outcomes by baseline DWI-ASPECTS categories were observed. Thus, different strategies for EVT based on time and ischaemic core size are warranted.
(© 2019 European Academy of Neurology.)
Databáze: MEDLINE
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