Time for a Time Window Extension: Insights from Late Presenters in the ESCAPE Trial
Autor: | Michael D. Hill, Daniela Iancu, Paul Brennan, Ashfaq Shuaib, B.R. Graham, W Montanera, P A Barber, Jeanne Teitelbaum, David Williams, Robert Willinsky, Andrew M. Demchuk, B.K. Menon, J.W. Evans, Donatella Tampieri, Thomas Devlin, Timo Krings, Jeremy L. Rempel, Tudor G Jovin, Jai Jai Shiva Shankar, Pooneh Pordeli, Chris Fanale, Daniel Roy, Blaise Baxter, Donald Frei, Mayank Goyal, Fahad S. Al-Ajlan, A.Y. Poppe, Frank L. Silver |
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Rok vydání: | 2017 |
Předmět: |
Male
medicine.medical_specialty Time Factors Computed Tomography Angiography Population Subgroup analysis 030204 cardiovascular system & hematology Asymptomatic Brain Ischemia law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Humans Medicine Radiology Nuclear Medicine and imaging education Stroke Aged Intracerebral hemorrhage education.field_of_study Interventional Groin business.industry Endovascular Procedures Absolute risk reduction Middle Aged medicine.disease Surgery Treatment Outcome medicine.anatomical_structure Female Neurology (clinical) medicine.symptom Tomography X-Ray Computed business 030217 neurology & neurosurgery |
Zdroj: | AJNR Am J Neuroradiol |
ISSN: | 1936-959X 0195-6108 |
Popis: | BACKGROUND AND PURPOSE: The safety and efficacy of endovascular therapy for large-artery stroke in the extended time window is not yet well-established. We performed a subgroup analysis on subjects enrolled within an extended time window in the Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) trial. MATERIALS AND METHODS: Fifty-nine of 315 subjects (33 in the intervention group and 26 in the control group) were randomized in the ESCAPE trial between 5.5 and 12 hours after last seen healthy (likely to have groin puncture administered 6 hours after that). Treatment effect sizes for all relevant outcomes (90-day mRS shift, mRS 0–2, mRS 0–1, and 24-hour NIHSS scores and intracerebral hemorrhage) were reported using unadjusted and adjusted analyses. RESULTS: There was no evidence of treatment heterogeneity between subjects in the early and late windows. Treatment effect favoring intervention was seen across all clinical outcomes in the extended time window (absolute risk difference of 19.3% for mRS 0–2 at 90 days). There were more asymptomatic intracerebral hemorrhage events within the intervention arm (48.5% versus 11.5%, P = .004) but no difference in symptomatic intracerebral hemorrhage. CONCLUSIONS: Patients with an extended time window could potentially benefit from endovascular treatment. Ongoing randomized controlled trials using imaging to identify late presenters with favorable brain physiology will help cement the paradigm of using time windows to select the population for acute imaging and imaging to select individual patients for therapy. |
Databáze: | OpenAIRE |
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