학술논문
Late Thrombectomy in Clinical Practice
Original Article
Original Article
Document Type
Academic Journal
Author
Source
Clinical Neuroradiology. September 2021, Vol. 31 Issue 3, p799, 12 p.
Subject
Language
English
ISSN
1869-1439
Abstract
Author(s): Moriz Herzberg [sup.1] [sup.2], Korbinian Scherling [sup.1], Robert Stahl [sup.1], Steffen Tiedt [sup.3], Frank A. Wollenweber [sup.4], Clemens Küpper [sup.5], Katharina Feil [sup.5] [sup.6], Robert Forbrig [sup.1], Maximilian Patzig [...]
Background and Purpose To provide real-world data on outcome and procedural factors of late thrombectomy patients. Methods We retrospectively analyzed patients from the multicenter German Stroke Registry. The primary endpoint was clinical outcome on the modified Rankin scale (mRS) at 3 months. Trial-eligible patients and the subgroups were compared to the ineligible group. Secondary analyses included multivariate logistic regression to identify predictors of good outcome (mRSâ¯[less than or equal to] 2). Results Of 1917 patients who underwent thrombectomy, 208 (11%) were treated within a time window [greater than or equal to]â¯6-24â¯h and met the baseline trial criteria. Of these, 27 patients (13%) were eligible for DAWN and 39 (19%) for DEFUSE3 and 156 patients were not eligible for DAWN or DEFUSE3 (75%), mainly because there was no perfusion imaging (62%; nâ¯= 129). Good outcome was not significantly higher in trial-ineligible (27%) than in trial-eligible (20%) patients (pâ¯= 0.343). Patients with large trial-ineligible CT perfusion imaging (CTP) lesions had significantly more hemorrhagic complications (33%) as well as unfavorable outcomes. Conclusion In clinical practice, the high number of patients with a good clinical outcome after endovascular therapy [greater than or equal to]â¯6-24â¯h as in DAWN/DEFUSE3 could not be achieved. Similar outcomes are seen in patients selected for EVTâ¯[greater than or equal to] 6â¯h based on factors other than CTP. Patients triaged without CTP showed trends for shorter arrival to reperfusion times and higher rates of independence.
Background and Purpose To provide real-world data on outcome and procedural factors of late thrombectomy patients. Methods We retrospectively analyzed patients from the multicenter German Stroke Registry. The primary endpoint was clinical outcome on the modified Rankin scale (mRS) at 3 months. Trial-eligible patients and the subgroups were compared to the ineligible group. Secondary analyses included multivariate logistic regression to identify predictors of good outcome (mRSâ¯[less than or equal to] 2). Results Of 1917 patients who underwent thrombectomy, 208 (11%) were treated within a time window [greater than or equal to]â¯6-24â¯h and met the baseline trial criteria. Of these, 27 patients (13%) were eligible for DAWN and 39 (19%) for DEFUSE3 and 156 patients were not eligible for DAWN or DEFUSE3 (75%), mainly because there was no perfusion imaging (62%; nâ¯= 129). Good outcome was not significantly higher in trial-ineligible (27%) than in trial-eligible (20%) patients (pâ¯= 0.343). Patients with large trial-ineligible CT perfusion imaging (CTP) lesions had significantly more hemorrhagic complications (33%) as well as unfavorable outcomes. Conclusion In clinical practice, the high number of patients with a good clinical outcome after endovascular therapy [greater than or equal to]â¯6-24â¯h as in DAWN/DEFUSE3 could not be achieved. Similar outcomes are seen in patients selected for EVTâ¯[greater than or equal to] 6â¯h based on factors other than CTP. Patients triaged without CTP showed trends for shorter arrival to reperfusion times and higher rates of independence.