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Ischemic Stroke
Original research
Eligibility for late endovascular treatment using DAWN, DEFUSE-3, and more liberal selection criteria in a stroke center
  1. Stefania Nannoni1,
  2. Davide Strambo1,
  3. Gaia Sirimarco1,
  4. Michael Amiguet2,
  5. Peter Vanacker3,
  6. Ashraf Eskandari1,
  7. Guillaume Saliou4,
  8. Max Wintermark5,
  9. Vincent Dunet4,
  10. Patrik Michel1
  1. 1 Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
  2. 2 Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
  3. 3 Department of Neurology, Antwerp University Hospital, Edegem, Antwerp, Belgium
  4. 4 Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
  5. 5 Department of Radiology, Neuroradiology Division, StanfordUniversity and Medical Center, Stanford, California, USA
  1. Correspondence to Dr Stefania Nannoni, Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne 1011, Switzerland; Stefania.Nannoni{at}chuv.ch

Abstract

Background and purpose The real-life application of DAWN and DEFUSE-3 trials has been poorly investigated. We aimed to identify the proportion of patients with acute ischemic stroke (AIS) eligible for late endovascular treatment (EVT) in our stroke center based on trial and more liberal selection criteria.

Methods All consecutive patients in our stroke registry (2003–2017) admitted within 5–23 hours of last proof of good health were selected if they had complete clinical and radiological datasets. We calculated the proportion of patients eligible for late EVT according to trial (DAWN and/or DEFUSE-3) and more liberal clinical/imaging mismatch criteria (including lower admission National Institutes of Health Stroke Scale score and Alberta Stroke Program Early CT Score for core estimation).

Results Of 1705 patients with AIS admitted to our comprehensive stroke center in the late time window, we identified 925 patients with complete clinical and radiological data. Among them, the proportions of late EVT eligibility were 2.5% (n=23) with DAWN, 5.1% (n=47) with DEFUSE-3, and 11.1% (n=103) with more liberal criteria. Considering late-arriving patients with large vessel occlusion (n=221), the percentages of eligible patients were 10.4%, 21.3%, and 46.6%, respectively. A favorable outcome was observed at comparable rates in treated patients selected by trial or liberal criteria (67% vs 58%, p=0.49).

Conclusions In a long-term stroke registry, the proportion of late EVT eligibility varied greatly according to selection criteria and referral pattern. Among late-arriving patients referred to our comprehensive stroke center, we found 5.6% eligible according to trial (DAWN/DEFUSE-3) and 11.1% according to liberal criteria. These data indicate that late EVT could be offered to a larger population of patients if more liberal criteria are applied.

  • thrombectomy
  • stroke
  • CT angiography
  • CT perfusion

https://doi.org/10.1136/neurintsurg-2019-015382

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    Footnotes

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    • Contributors SN studied the concept and design, helped with analysis and interpretation, and prepared the article. DS, GSi and PV helped with interpretation of data and critical revision of the article for important intellectual content. MA carried out data analysis and interpretation and helped with preparation of the article. AE helped with data acquisition and analysis. VD and GSa helped with radiological data acquisition and critical revision of the article for important intellectual content. MW contributed to the conception and design and helped with the interpretation of data. PM studied the concept and design, helped with data acquisition, analysis and interpretation, critical revision of the article for important intellectual content, and study supervision.

    • Funding This work was supported by the Swiss National Science Foundation (grant number: 320030_182654).

    • Competing interests GSi: research grant from the Swiss Heart Foundation, congress travel support from Bayer and Shire and consultant for scientific advisory boards for Amgen and Daiichi-Sankyo. PV: research grants from the National Institute of Disease and Health Insurance (NIDHI/Belgium) through his institution; speaker fees from Daiichi-Sankyo, Pfizer and Alexion; honoraria from scientific advisory boards from Boehringer-Ingelheim. PM: research grants from the Swiss Heart Foundation and the Swiss National Science Foundation.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Anonymized data can be shared by request from any qualified investigator