학술논문

Endovascular Therapy in the Extended Time Window for Large Vessel Occlusion in Patients With Pre-Stroke Disability.
Document Type
Academic Journal
Author
Tanaka K; Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan.; Stroke Center, Kindai University Hospital, Osakasayama, Japan.; Yamagami H; Division of Stroke Prevention and Treatment, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.; Qureshi MM; Department of Radiology, Radiation Oncology, Boston Medical Center, Boston, MA, USA.; Uchida K; Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.; Siegler JE; Department of Neurology, University of Chicago, Chicago, IL, USA.; Nogueira RG; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.; Yoshimura S; Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.; Sakai N; Department of Neurosurgery, Kobe City Medical General Hospital, Kobe, Japan.; Martinez-Majander N; Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.; Nagel S; Department of Neurology, Klinikum Ludwigshafen, Heidelberg University Hospital, Ludwigshafen, Germany.; Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.; Demeestere J; Department of Neurology, Leuven University Hospital, Leuven, Belgium.; Puetz V; Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.; Dresden Neurovascular Center, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.; Haussen DC; Department of Neurology, Grady Memorial Hospital, Atlanta, GA, USA.; Abdalkader M; Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.; Olive-Gadea M; Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain.; Mohammaden MH; Department of Neurology, Grady Memorial Hospital, Atlanta, GA, USA.; Marto JP; Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.; Dusart A; Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium.; Winzer S; Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.; Tomppo L; Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.; Caparros F; Department of Neurology, Centre Hospitalier Universitaire de Lille, University of Lille, Lille, France.; Henon H; Department of Neurology, Centre Hospitalier Universitaire de Lille, University of Lille, Lille, France.; Bellante F; Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium.; Ramos JN; Department of Neuroradiology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.; Ortega-Gutierrez S; Department of Neurology, University of Iowa, Iowa City, IA, USA.; Sheth SA; Department of Neurology, UTHealth Houston, Houston, TX, USA.; Nannoni S; Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.; Kaesmacher J; Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, University of Bern, Bern, Switzerland.; Vandewalle L; Department of Neurology, Leuven University Hospital, Leuven, Belgium.; Salazar-Marioni S; Department of Neurology, UTHealth Houston, Houston, TX, USA.; Farooqui M; Department of Neurology, University of Iowa, Iowa City, IA, USA.; Virtanen P; Department of Radiology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.; Ventura R; Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.; Zaidi S; Department of Neurology, University of Toledo, Toledo, OH, USA.; Castonguay AC; Department of Neurology, University of Toledo, Toledo, OH, USA.; Puri AS; Division of Interventional Neuroradiology, University of Massachusetts Memorial Medical Center, Worcester, MA, USA.; Farzin B; Department of Radiology, Centre Hospitalier de l'Universite de Montreal, Montreal, Canada.; Masoud HE; Department of Neurology, State University of New York, Upstate Medical University, Syracuse, NY, USA.; Klein P; Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.; Jesser J; Department of Radiology, Heidelberg University Hospital, Heidelberg, Germany.; Requena M; Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain.; Dobrocky T; Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, University of Bern, Bern, Switzerland.; Kaiser DPO; Department of Diagnostic and Interventional Neuroradiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.; Peltola E; Department of Radiology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.; Strambo D; Department of Neurology, Lausanne University Hospital, Lausanne, Switzerland.; Möhlenbruch MA; Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.; Lin E; Neuroscience and Stroke Program, Bon Secours Mercy Health St. Vincent Hospital, Toledo, OH, USA.; Ringleb PA; Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.; Zaidat OO; Neuroscience and Stroke Program, Bon Secours Mercy Health St. Vincent Hospital, Toledo, OH, USA.; Cordonnier C; Department of Neurology, Centre Hospitalier Universitaire de Lille, University of Lille, Lille, France.; Roy D; Department of Radiology, Centre Hospitalier de l'Universite de Montreal, Montreal, Canada.; Lemmens R; Department of Neurology, Leuven University Hospital, Leuven, Belgium.; Ribo M; Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain.; Strbian D; Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.; Fischer U; Department of Neurology, University Hospital Basel, Switzerland.; Department of Neurology, University Hospital Bern, Switzerland.; Michel P; Department of Neurology, Lausanne University Hospital, Lausanne, Switzerland.; Raymond J; Department of Radiology, Centre Hospitalier de l'Universite de Montreal, Montreal, Canada.; Nguyen TN; Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.; Department of Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
Source
Publisher: Korean Stroke Society Country of Publication: Korea (South) NLM ID: 101602023 Publication Model: Print-Electronic Cited Medium: Print ISSN: 2287-6391 (Print) Linking ISSN: 22876391 NLM ISO Abbreviation: J Stroke Subsets: PubMed not MEDLINE
Subject
Language
English
ISSN
2287-6391
Abstract
Background and Purpose: We compared the outcomes of endovascular therapy (EVT) in an extended time window in patients with large-vessel occlusion (LVO) between patients with and without pre-stroke disability.
Methods: In this prespecified analysis of the multinational CT for Late Endovascular Reperfusion study (66 participating sites, 10 countries between 2014 and 2022), we analyzed data from patients with acute ischemic stroke with a pre-stroke modified Rankin Scale (mRS) score of 0-4 and LVO who underwent EVT 6-24 hours from the time last seen well. The primary outcome was the composite of functional independence (FI; mRS score 0-2) or return to the pre-stroke mRS score (return of Rankin, RoR) at 90 days. Outcomes were compared between patients with pre-stroke disability (pre-stroke mRS score 2-4) and those without (mRS score 0-1).
Results: A total of 2,231 patients (median age, 72 years; median National Institutes of Health Stroke Scale score, 16) were included in the present analysis. Of these, 564 (25%) had pre-stroke disability. The primary outcome (FI or RoR) was observed in 30.7% of patients with pre-stroke disability (FI, 16.5%; RoR, 30.7%) compared to 44.1% of patients without (FI, 44.1%; RoR, 13.0%) (P<0.001). In multivariable logistic regression analysis with inverse probability of treatment weighting, pre-stroke disability was not associated with significantly lower odds of achieving FI or RoR (adjusted odds ratio 0.73, 95% confidence interval 0.43-1.25). Symptomatic intracranial hemorrhage occurred in 6.3% of both groups (P=0.995).
Conclusion: A considerable proportion of patients with late-presenting LVO and pre-stroke disability regained pre-stroke mRS scores after EVT. EVT may be appropriate for patients with pre-stroke disability presenting in the extended time window.