In:
Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. Suppl_1 ( 2019-02)
Abstract:
Background and Purpose: The DAWN trial showed the efficacy of endovascular thrombectomy between 6 to 24hours after time last known well (TLKW) in acute stroke patients with clinical-imaging mismatch. We examined the validity of patient selection using Alberta Stroke Program Early CT Score on diffusion weighted imaging (DWI-ASPECTS) in a real-world setting. Methods: In a Japanese nationwide registry study, 2420 patients with acute stroke due to large vessel occlusion within 24 hours from onset/TLKW were registered between October 2014 and January 2017. Among them, patients were included according to the inclusion criteria of the DAWN trial where ischemic core volume was replaced with DWI-ASPECTS: occlusion of the internal carotid artery or the middle cerebral artery M1 portion, 6 to 24 hours from onset/TLKW, DWI-ASPECTS ≥7 and initial NIHSS ≥10, and DWI-ASPECTS ≥6 and NIHSS ≥20 in patients younger than 80 years old. The favorable outcome was defined as a modified Rankin Scale of 0 to 2 at 90 days after onset. Results: Of 78 patients who were eligible to inclusion criteria, 54 (69%, mean 75±13 years old) underwent endovascular therapy (EVT) and 24 (31%, mean 76±14 years old) did not. Median initial NIHSS was 18 (IQR, 13-23) and 20 (IQR, 14-23), respectively (p = 0.67). Initial DWI-ASPECTS was significantly higher in the EVT group than in the non-EVT group (median [IQR], 8 [7-9] vs 7 [7-8], p = 0.009). The favorable outcome was achieved in 52% of the EVT group and 13% of the non-EVT group (adjusted odds ratio, 8.1; 95% CI, 2.0-33.3, p = 0.004) . In terms of safety outcome, any intracranial hemorrhage within 72 hours was not different between the two groups (24% vs 33%, p = 0.56). The recurrence of stroke (5.6% vs 4.2%, p = 1.00) and mortality (4.2% vs 3.7%, p = 1.00) within 90 days were also not different. Conclusions: Patient selection using clinical-DWI mismatch can be useful to determine the indication of endovascular treatment in late presenting stroke with anterior large vessel occlusion.
Type of Medium:
Online Resource
ISSN:
0039-2499
,
1524-4628
DOI:
10.1161/str.50.suppl_1.WP40
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2019
detail.hit.zdb_id:
1467823-8
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