Association between time to treatment and clinical outcomes in endovascular thrombectomy beyond 6 hours without advanced imaging selection.

Autor:	Dhillon PS; Interventional Neuroradiology, Queens Medical Centre Nottingham University Hospitals NHS Trust, Nottingham, UK permesh.dhillon@nhs.net.; NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK., Butt W; Interventional Neuroradiology, Queen Elizabeth Hospital University Hospitals Birmingham NHS Trust, Birmingham, UK., Podlasek A; NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK., McConachie N; Interventional Neuroradiology, Queens Medical Centre Nottingham University Hospitals NHS Trust, Nottingham, UK., Lenthall R; Interventional Neuroradiology, Queens Medical Centre Nottingham University Hospitals NHS Trust, Nottingham, UK., Nair S; Interventional Neuroradiology, Queens Medical Centre Nottingham University Hospitals NHS Trust, Nottingham, UK., Malik L; Interventional Neuroradiology, Queens Medical Centre Nottingham University Hospitals NHS Trust, Nottingham, UK., Bhogal P; Interventional Neuroradiology, The Royal London Hospital Barts Health NHS Trust, London, UK., Makalanda HLD; Interventional Neuroradiology, The Royal London Hospital Barts Health NHS Trust, London, UK., Spooner O; Stroke Medicine, The Royal London Hospital Barts Health NHS Trust, London, UK., Krishnan K; Stroke Medicine, Queen's Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK., Sprigg N; Stroke Medicine, Queen's Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK.; Strokes Trial Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK., Mortimer A; Interventional Neuroradiology, Southmead Hospital North Bristol NHS Trust, Bristol, Bristol, UK., Booth TC; Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, London, UK.; School of Biomedical Engineering and Imaging Sciences, King's College London, London, London, UK., Lobotesis K; Interventional Neuroradiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, London, UK., White P; Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK., James MA; University of Exeter Medical School, Exeter, UK.; Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.; Sentinel Stroke National Audit Programme, King's College London, London, UK., Bath P; Stroke Medicine, Queen's Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK.; Strokes Trial Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK., Dineen RA; NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK.; Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK., England TJ; Strokes Trial Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK.; Stroke, Mental Health and Clinical Neuroscience, School of Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK.; Stroke, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK.
Jazyk:	angličtina
Zdroj:	Journal of neurointerventional surgery [J Neurointerv Surg] 2023 Apr; Vol. 15 (4), pp. 336-342. Date of Electronic Publication: 2022 Mar 16.
DOI:	10.1136/neurintsurg-2021-018564
Abstrakt:	Background: The effectiveness and safety of endovascular thrombectomy (EVT) in the late window (6-24 hours) for acute ischemic stroke (AIS) patients selected without advanced imaging is undetermined. We aimed to assess clinical outcomes and the relationship with time-to-EVT treatment beyond 6 hours of stroke onset without advanced neuroimaging. Methods: Patients who underwent EVT selected with non-contrast CT/CT angiography (without CT perfusion or MR imaging), between October 2015 and March 2020, were included from a national stroke registry. Functional and safety outcomes were assessed in both early (<6 hours) and late windows with time analyzed as a continuous variable. Results: Among 3278 patients, 2610 (79.6%) and 668 (20.4%) patients were included in the early and late windows, respectively. In the late window, for every hour delay, there was no significant association with shift towards poorer functional outcome (modified Rankin Scale (mRS)) at discharge (adjusted common OR 0.98, 95% CI 0.94 to 1.01, p=0.27) or change in predicted functional independence (mRS ≤2) (24.5% to 23.3% from 6 to 24 hours; aOR 0.99, 95% CI0.94 to 1.04, p=0.85). In contrast, predicted functional independence was time sensitive in the early window: 5.2% reduction per-hour delay (49.4% to 23.5% from 1 to 6 hours, p=0.0001). There were similar rates of symptomatic intracranial hemorrhage (sICH) (3.4% vs 4.6%, p=0.54) and in-hospital mortality (12.9% vs 14.6%, p=0.33) in the early and late windows, respectively, without a significant association with time. Conclusion: In this real-world study, there was minimal change in functional disability, sICH and in-hospital mortality within and across the late window. While confirmatory randomized trials are needed, these findings suggest that EVT remains feasible and safe when performed in AIS patients selected without advanced neuroimaging between 6-24 hours from stroke onset. Competing Interests: Competing interests: PBh is Stroke Association Professor of Stroke Medicine and an Emeritus NIHR Senior Investigator. MAJ has received lecture and consultancy fees from Medtronic. PBl has a consulting agreement with Phenox, Balt, Braniomix, Neurovasc Technologies and Cerenovus. PW serves on the editorial board of the Journal of NeuroInterventional Surgery. No other disclosures or competing interests declared by the remaining authors. (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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