Influence of time to endovascular stroke treatment on outcomes in the early versus extended window paradigms.
BACKGROUND: The effect of time from stroke onset to thrombectomy in the extended time window remains poorly characterized.
AIM: We aimed to analyze the relationship between time to treatment and clinical outcomes in the early versus extended time windows.
METHODS: Proximal anterior circulation occlusion patients from a multicentric prospective registry were categorized into early (≤6 h) or extended (>6-24 h) treatment window. Patients with baseline National Institutes of Health Stroke Scale (NIHSS) ≥ 10 and intracranial internal carotid artery or middle cerebral artery-M1-segment occlusion and pre-morbid modified Rankin scale (mRS) 0-1 ("DAWN-like" cohort) served as the population for the primary analysis. The relationship between time to treatment and 90-day mRS, analyzed in ordinal (mRS shift) and dichotomized (good outcome, mRS 0-2) fashion, was compared within and across the extended and early windows.
RESULTS: A total of 1603 out of 2008 patients qualified. Despite longer time to treatment (9[7-13.9] vs. 3.4[2.5-4.3] h,
CONCLUSIONS: The impact of time to thrombectomy on outcomes appears to be time dependent with a steep influence in the early followed by a less significant plateau in the extended window. However, every effort should be made to shorten treatment times regardless of ischemia duration.
Published In/Presented At
Nogueira, R. G., Jovin, T. G., Haussen, D. C., Gupta, R., Jadhav, A., Budzik, R. F., Baxter, B., Krajina, A., Bonafe, A., Malek, A., Narata, A. P., Shields, R., Zhang, Y., Morgan, P., Bartolini, B., English, J., Mohammaden, M., Frankel, M. R., Liebeskind, D. S., Veznedaroglu, E., … Trevo Registry and DAWN Trial Investigators (2022). Influence of time to endovascular stroke treatment on outcomes in the early versus extended window paradigms. International journal of stroke : official journal of the International Stroke Society, 17(3), 331–340. https://doi.org/10.1177/17474930211006304
Diagnosis | Medicine and Health Sciences | Other Analytical, Diagnostic and Therapeutic Techniques and Equipment | Radiology
Department of Radiology and Diagnostic Medical Imaging