Safety and clinical outcomes of endovascular therapy versus medical management in late presentation of large ischemic stroke-Reference-Cited by-同舟云学术

Safety and clinical outcomes of endovascular therapy versus medical management in late presentation of large ischemic stroke

Published:2024-05-17 Issue: Volume: Page:
ISSN:2396-9873
Container-title:European Stroke Journal
language:en
Short-container-title:European Stroke Journal

Author:

Mujanovic Adnan¹^ORCID,Strbian Daniel²^ORCID,Demeestere Jelle³⁴^ORCID,Marto João Pedro⁵^ORCID,Puetz Volker⁶⁷,Nogueira Raul G⁸⁹,Abdalkader Mohamad¹⁰¹¹,Nagel Simon¹²¹³,Raymond Jean¹⁴,Ribo Marc¹⁵,Michel Patrik¹⁶,Yoshimura Shinichi¹⁷,Zaidat Osama O¹⁸,Winzer Simon⁶⁷,Ortega-Gutierrez Santiago¹⁹,Sheth Sunil A²⁰,Siegler James E²¹,Dusart Anne²²,Haussen Diogo C²³,Henon Hilde²⁴,Serrallach Bettina L¹,Mohammaden Mahmoud H²³,Möhlenbruch Markus A²⁵^ORCID,Olive-Gadea Marta¹⁵,Puri Ajit S²⁶,Sakai Nobuyuki²⁷^ORCID,Klein Piers¹⁰¹¹^ORCID,Tomppo Liisa²^ORCID,Caparros Francois²⁴,Ramos João Nuno²⁸^ORCID,Jumaa Mouhammad²⁹,Zaidi Syed²⁹,Dobrocky Tomas¹,Martinez-Majander Nicolas²^ORCID,Nannoni Stefania³⁰,Bellante Flavio²²^ORCID,Rodriguez-Calienes Aaron¹⁹,Salazar-Marioni Sergio²⁰^ORCID,Virtanen Pekka³¹^ORCID,Kaiser Daniel PO⁷³²,Ventura Rita⁵,Jesser Jessica²⁵^ORCID,Castonguay Alicia C²⁹,Qureshi Muhammad M⁹³³,Masoud Hesham E³⁴,Galecio-Castillo Milagros¹⁹,Requena Manuel¹⁵^ORCID,Lauha Riikka³¹,Hu Wei³⁵,Lin Eugene¹⁸,Miao Zhongrong³⁶,Roy Daniel¹⁴,Yamagami Hiroshi³⁷,Seiffge David J³⁸^ORCID,Strambo Davide¹⁶,Ringleb Peter A¹³,Lemmens Robin³⁴,Fischer Urs³⁸³⁹,Nguyen Thanh N¹¹⁴⁰^ORCID,Kaesmacher Johannes¹

Affiliation:

1. Diagnostic and Interventional Neuroradiology, University Hospital Bern, University of Bern, Bern, Switzerland

2. Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland

3. Neurology, UZ Leuven, Leuven, Belgium

4. Laboratory for Neurobiology, KU Leuven, Leuven, Belgium

5. Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal

6. Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

7. Dresden Neurovascular Center, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

8. Neurology, University of Pittsburgh Medical Center, Pittsburgh, USA

9. Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, USA

10. Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, USA

11. Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, USA

12. Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany

13. Neurology, Heidelberg University Hospital, Heidelberg, Germany

14. Interventional Neuroradiology, Centre Hospitalier de l’Universite de Montreal, Radiology, Montreal, Canada

15. Neurology, Hospital Vall d’Hebron, Barcelona, Spain

16. Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

17. Neurosurgery, Hyogo Medical University, Japan

18. Neuroscience and Stroke Program, Bon Secours Mercy Health St. Vincent Hospital, Toledo, USA

19. Neurology, University of Iowa, Iowa City, USA

20. Neurology, UTHealth McGovern Medical School, Neurology, Houston, USA

21. Neurology, University of Chicago, Chicago, USA

22. Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium

23. Neurology, Grady Memorial Hospital, Atlanta, USA

24. Neurology, Centre Hospitalier Universitaire de Lille, Lille, France

25. Radiology, Heidelberg University Hospital, Heidelberg, Germany

26. Division of Interventional Neuroradiology, University of Massachusetts Memorial Medical Center, Worcester, USA

27. Neurosurgery, Seijinkai Shimizu Hospital, Kyoto, Japan

28. Neuroradiology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Occidental, Lisbon, Portugal

29. Neurology, University of Toledo, Toledo, USA

30. Clinical Neurosciences, University of Cambridge, Cambridge, UK

31. Radiology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland

32. Institute of Neuroradiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

33. Radiation Oncology, Boston Medical Center, USA

34. Neurology, State University of New York, Syracuse, USA

35. Neurology, The First Affiliated Hospital of USTC, China

36. Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China

37. Division of Stroke Prevention and Treatment, University of Tsukuba, Tsukuba, Japan

38. Neurology, University Hospital Bern, University of Bern, Bern, Switzerland

39. Neurology, University Hospital Basel, University of Basel, Basel, Switzerland

40. Neurology, Boston Medical Center, Boston, USA

Abstract

Introduction: The benefit of endovascular therapy (EVT) among stroke patients with large ischemic core (ASPECTS 0–5) in the extended time window outside of trial settings remains unclear. We analyzed the effect of EVT among these stroke patients in real-world settings. Patients and methods: The CT for Late Endovascular Reperfusion (CLEAR) study recruited patients from 66 centers in 10 countries between 01/2014 and 05/2022. The extended time-window was defined as 6–24 h from last-seen-well to treatment. The primary outcome was shift of the 3-month modified Rankin scale (mRS) score. Safety outcomes included symptomatic intracranial hemorrhage (sICH) and mortality. Outcomes were analyzed with ordinal and logistic regressions. Results: Among 5098 screened patients, 2451 were included in the analysis (median age 73, 55% women). Of patients with ASPECTS 0–5 ( n = 310), receiving EVT ( n = 209/310) was associated with lower 3-month mRS when compared to medical management (median 4 IQR 3–6 vs 6 IQR 4–6; aOR 0.4, 95% CI 0.2–0.7). Patients undergoing EVT had higher sICH (11.2% vs 4.0%; aOR 4.1, 95% CI 1.2–18.8) and lower mortality (31.6% vs 58.4%, aOR 0.4; 95% CI 0.2–0.9) compared to medically managed patients. The relative benefit of EVT was comparable between patients with ASPECTS 0 and 5 and 6–10 in the extended time window (interaction aOR 0.9; 95% CI 0.5–1.7). Conclusion: In the extended time window, patients with ASPECTS 0–5 may have preserved relative treatment benefit of EVT compared to patients with ASPECTS 6–10. These findings are in line with recent trials showing benefit of EVT among real-world patients with large ischemic core in the extended time window. Trial registration number: clinicaltrials.gov; Unique identifier: NCT04096248

Publisher

SAGE Publications

Link

https://journals.sagepub.com/doi/pdf/10.1177/23969873241249406

Reference28 articles.

1. European Stroke Organisation (ESO) – European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischaemic StrokeEndorsed by Stroke Alliance for Europe (SAFE)

2. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials

3. Endovascular Therapy for Acute Stroke with a Large Ischemic Region

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3. Endovascular Therapy in the Extended Time Window for Large Vessel Occlusion in Patients With Pre-Stroke Disability;Journal of Stroke;2024-05-31