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Endovascular treatment in anterior circulation stroke beyond 6.5 hours after onset or time last seen well:results from the MR CLEAN Registry

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Stroke & vascular Neurology 2021年第4期6卷 572-580,I0037-I0048页

作者： Luuk Dekker Esmee venema f anne v pirson Charles B L M Majoie Bart J Emmer Ivo G H Jansen Maxim J H L Mulder Robin Lemmens Robert-Jan B Goldhoorn Marieke J H Wermer Jelis Boiten Geert J LycklamaàNijeholt Yvo B W E M Roos Adriaan C G M van Es Hester f Lingsma Diederik W J Dippel Wim H van Zwam Robert J van Oostenbrugge Ido R van den Wijngaard on behalf of the MR CLEAN Registry investigators Neurology Leiden University Medical CentreLeidenThe Netherlands Neurology Erasmus MCRotterdamThe Netherlands Public Health Erasmus MCRotterdamThe Netherlands Neurology Maastricht University Medical Centre+MaastrichtThe Netherlands Radiology and Nuclear Medicine Amsterdam University Medical CentreLocation AMCAmsterdamThe Netherlands Neurology University Hospitals LeuvenLeuvenBelgium Neurosciences Experimental Neurology and Leuven Brain InstituteUniversity of LeuvenLeuvenBelgium vIB Center for Brain&Disease ResearchLaboratory of NeurobiologyLeuvenBelgium Neurology Haaglanden Medical CentreDen HaagThe Netherlands Radiology Haaglanden Medical CentreDen HaagThe Netherlands Neurology Amsterdam University Medical CentreLocation AMCAmsterdamThe Netherlands Radiology Leiden University Medical CentreLeidenThe Netherlands Radiology Maastricht University Medical Centre+MaastrichtThe Netherlands

Background Randomised controlled trials with perfusion selection have shown benefit of endovascular treatment(EvT)for ischaemic stroke between 6 and 24 hours after symptom onset or time last seen ***,outcomes after EvT in these late window patients without perfusion imaging are largely *** assessed their characteristics and outcomes in routine clinical *** The Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry,a prospective,multicentre study in the Netherlands,included patients with an anterior circulation occlusion who underwent EvT between 2014 and *** perfusion was no standard imaging *** used adjusted ordinal logistic regression analysis to compare patients treated within versus beyond 6.5 hours after propensity score matching on age,prestroke modified Rankin Scale(mRS),National Institutes of Health Stroke Scale,Alberta Stroke Programme Early CT Score(ASPECTS),collateral status,location of occlusion and treatment with intravenous *** included 3-month mRS score,functional independence(defined as mRS 0-2),and *** Of 3264 patients who underwent EvT,106(3.2%)were treated beyond 6.5 hours(median 8.5,IQR 6.9-10.6),of whom 93(87.7%)had unknown time of stroke *** perfusion was not performed in 87/106(80.2%)late window *** window patients were younger(mean 67 vs 70 years,pvs 9,pvs 57.7%,p=0.03).No differences were observed in proportions of functional independence(43.3%vs 40.5%,p=0.57)or death(24.0%vs 28.9%,p=0.28).After matching,outcomes remained similar(adjusted common OR for 1 point improvement in mRS 1.04,95%CI 0.56 to 1.93).Conclusions Without the use of CT perfusion selection criteria,EvT in the 6.5-24-hour time window was not associated with poorer outcome in selected patients with favourable clinical and CT/C

关键词： treatment beyond Registry

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