RT Journal Article
SR Electronic
T1 Association between time to treatment and clinical outcomes in endovascular thrombectomy beyond 6 hours without advanced imaging selection
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 336
OP 342
DO 10.1136/neurintsurg-2021-018564
VO 15
IS 4
A1 Permesh Singh Dhillon
A1 Waleed Butt
A1 Anna Podlasek
A1 Norman McConachie
A1 Robert Lenthall
A1 Sujit Nair
A1 Luqman Malik
A1 Pervinder Bhogal
A1 Hegoda Levansri Dilrukshan Makalanda
A1 Oliver Spooner
A1 Kailash Krishnan
A1 Nikola Sprigg
A1 Alex Mortimer
A1 Thomas Calvert Booth
A1 Kyriakos Lobotesis
A1 Philip White
A1 Martin A James
A1 Philip Bath
A1 Robert A Dineen
A1 Timothy J England
YR 2023
UL http://jnis.bmj.com/content/15/4/336.abstract
AB 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.Data may be obtained from a third party and are not publicly available. Data access requests should be directed to SSNAP as the data provider and HQIP as the data controller.