Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/18451
Title: Outcomes of endovascular treatment for acute large-vessel ischaemic stroke more than 6 h after symptom onset.
Austin Authors: Motyer, R;Kok, H K;Asadi, Hamed ;O'Hare, A;Brennan, P;Power, S;Looby, S;Nicholson, P;Williams, D ;Murphy, S;Hill, M D;Goyal, M;McManus, J;O'Brien, P;Thornton, J
Affiliation: Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin 9, Ireland
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Department of Radiology, Cumming School of Medicine, University of Calgary, AB, Canada
Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland
Interventional Neuroradiology Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
Department of Interventional Radiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia
School of Medicine, University College Dublin, Dublin 4, Ireland
School of Medicine, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland
Department of Geriatric and Stroke Medicine, The Mater Misericordiae University Hospital, Dublin 7, Ireland
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada
Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Department of Radiology, Interventional Neuroradiology Service, Monash Medical Centre, Clayton, VIC, Australia
Department of Radiology, Interventional Neuroradiology Service, Beaumont Hospital, Dublin 9, Ireland
Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Division of Ageing, Therapeutics and Rehabilitation, University Hospital Limerick, Dooradoyle, Limerick, Ireland
Department of Geriatric and Stroke Medicine, Naas General Hospital, Naas East, Naas, Kildare, Ireland
Issue Date: Dec-2017
metadata.dc.date: 2017-09-25
Publication information: Journal of internal medicine 2017; 282(6): 537-545
Abstract: BACKGROUND AND OBJECTIVES: Benefit from endovascular thrombectomy (EVT) for large-vessel occlusion (LVO) acute ischaemic stroke (AIS) is well demonstrated. Furthermore, emerging evidence supports efficacy in appropriately selected patients treated beyond current recommendations of 6 h. We evaluated clinical outcomes in patients undergoing late EVT at our institution. METHODS: Retrospective review of prospectively collected clinical database on 355 patients who underwent EVT for LVO AIS. Data collected consisted of patient demographics, radiological findings and outcome details. Outcomes, including 90-day functional status, recanalization, symptomatic intracranial haemorrhage (sICH) and 90-day mortality, for patients undergoing EVT <6 h, >6 h, and >7.3 h, were compared. RESULTS: A total of 355 patients underwent EVT for LVO AIS at our institution during the review period, with 74 (21%) patients treated ≥6 h from symptom onset. Successful recanalization was achieved in 285 (80%) patients, with 228 (81%) achieving a mTICI ≥2b in the <6 h group, and 57 (77%) in the >6 h group (P = 0.429). Ninety-day functional independence (mRS 0-2) was achieved in 162 (46%) patients, with 130 (46%) achieving a mRS of 0-2 in the <6 h group, and 32 (43%) in the >6 h group (P = 0.643). No significant differences were found in rates of sICH or 90-day mortality. No significant differences in functional independence, recanalization rates, sICH or mortality were identified in patients treated with EVT >7.3 h compared to <7.3 h. CONCLUSIONS: In appropriately selected patients, EVT >6 h was associated with comparable outcomes to those treated <6 h. These data support a physiological approach to patient selection.
URI: http://ahro.austin.org.au/austinjspui/handle/1/18451
DOI: 10.1111/joim.12680
ORCID: 0000-0003-2475-9727
PubMed URL: 28875550
Type: Journal Article
Subjects: delayed presentation
endovascular
intervention
interventional neuroradiology
ischaemia reperfusion
large-vessel occlusion
neurology
radiology
recanalization
Stroke
thrombectomy
thrombolysis
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