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.
Background: Recent trials have shown benefit of thrombectomy in carefully selected patients in the extended (>6 hours) window. However, it is not clear if the outcomes differ from those undergoing thrombectomy in the conventional (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 data of consecutive patients who underwent thrombectomy in a single center cohort. Demographics, comorbidities, National Institute of Health Stroke Scale (NIHSS), vessel occlusion location, onset to skin puncture time, core infarct volume on initial CTP, recanalization (mTICI IIb/III) rates, final infarct volume and modified rankin scale (mRS) at 90 days were compared between patients who underwent thrombectomy in conventional (0-6 hours) and extended (>6 hour) window. Results: 119 patients were studied of which 55% were female. Univariate analysis showed that the groups (Conventional vs. Extended) were balanced for age (p=0.37), NIHSS (p=0.35), vessel occlusion location (p=0.51), initial core infarct volume (p=0.64) and recanalization (mTICI IIb/III) rates (p=0.55). Final infarct volume (p=0.18) and favorable outcome (mRS 0-2) at 90 days (p=0.65) were similar. Shift analysis did not reveal any significant difference in 90 day outcome (p=0.34). (Figure) After adjustment; age (p=0.004) and final infarct volume (p<0.001) were predictive of favorable outcome. Conclusion: Tissue based selection with CTP for thrombectomy in large vessel occlusion stroke is independent of onset time for favorable functional outcome.
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