Abstract | BACKGROUND AND PURPOSE: Recent trials have shown benefit of thrombectomy in patients selected by penumbral imaging in the late (>6 hours) window. However, the role penumbral imaging is not clear in the early (0-6 hours) window. We sought to evaluate if time to treatment modifies the effect of endovascular reperfusion in stroke patients with evidence of salvageable tissue on CT perfusion ( CTP). METHODS: We retrospectively analyzed consecutive patients who underwent thrombectomy in a single center. Demographics, comorbidities, National Institute of Health Stroke Scale (NIHSS), rtPA administration, ASPECTS, core infarct volume, onset to skin puncture time, recanalization (mTICI IIb/III), final infarct volume were compared between patients with good and poor 90-day outcomes (mRS 0-2 vs. 3-6). Multivariable logistic regression analyses were used to identify independent predictors of a good (mRS 0-2) 90-day outcome. RESULTS: A total of 235 patients were studied, out of which 52.3% were female. Univariate analysis showed that the groups (early vs. late) were balanced for age ( P = .23), NIHSS (P = .63), vessel occlusion location (P = .78), initial core infarct volume (P = .15), and recanalization (mTICI IIb/III) rates (P = .22). Favorable outcome (mRS 0-2) at 90 days ( P = .30) were similar. There was a significant difference in final infarct volume (P = .04). Shift analysis did not reveal any significant difference in 90-day outcome (P = .14). After adjustment; age (P < .001), NIHSS (P = .01), recanalization (P = .008), and final infarct volume (P < .001) were predictive of favorable outcome. CONCLUSIONS: Penumbral imaging-based selection of patients for thrombectomy is effective regardless of onset time and yields similar functional outcomes in early and late window patients.
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Authors | Chantal Bhan, Tracy J Koehler, Lee Elisevich, Justin Singer, Paul Mazaris, Elysia James, Joseph Zachariah, Jordan Combs, Michelle Dejesus, Tricia Tubergen, Laurel Packard, Jiangyong Min, Nabil Wees, Nadeem Khan, Todd Mulderink, Muhib Khan |
Journal | Journal of neuroimaging : official journal of the American Society of Neuroimaging
(J Neuroimaging)
Vol. 30
Issue 3
Pg. 315-320
(05 2020)
ISSN: 1552-6569 [Electronic] United States |
PMID | 32072729
(Publication Type: Journal Article)
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Copyright | © 2020 by the American Society of Neuroimaging. |
Chemical References |
- Fibrinolytic Agents
- Tissue Plasminogen Activator
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Topics |
- Aged
- Aged, 80 and over
- Female
- Fibrinolytic Agents
(therapeutic use)
- Humans
- Male
- Middle Aged
- Retrospective Studies
- Stroke
(diagnostic imaging, drug therapy, surgery)
- Thrombectomy
(methods)
- Time-to-Treatment
- Tissue Plasminogen Activator
(therapeutic use)
- Tomography, X-Ray Computed
(methods)
- Treatment Outcome
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