Late Thrombectomy in Clinical Practice : Retrospective Application of DAWN/DEFUSE3 Criteria within the German Stroke Registry.
Endovascular therapy
Late thrombectomy
Outcome
Stroke
Journal
Clinical neuroradiology
ISSN: 1869-1447
Titre abrégé: Clin Neuroradiol
Pays: Germany
ID NLM: 101526693
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
received:
07
12
2020
accepted:
28
04
2021
pubmed:
8
6
2021
medline:
26
11
2021
entrez:
7
6
2021
Statut:
ppublish
Résumé
To provide real-world data on outcome and procedural factors of late thrombectomy patients. We retrospectively analyzed patients from the multicenter German Stroke Registry. The primary endpoint was clinical outcome on the modified Rankin scale (mRS) at 3 months. Trial-eligible patients and the subgroups were compared to the ineligible group. Secondary analyses included multivariate logistic regression to identify predictors of good outcome (mRS ≤ 2). Of 1917 patients who underwent thrombectomy, 208 (11%) were treated within a time window ≥ 6-24 h and met the baseline trial criteria. Of these, 27 patients (13%) were eligible for DAWN and 39 (19%) for DEFUSE3 and 156 patients were not eligible for DAWN or DEFUSE3 (75%), mainly because there was no perfusion imaging (62%; n = 129). Good outcome was not significantly higher in trial-ineligible (27%) than in trial-eligible (20%) patients (p = 0.343). Patients with large trial-ineligible CT perfusion imaging (CTP) lesions had significantly more hemorrhagic complications (33%) as well as unfavorable outcomes. In clinical practice, the high number of patients with a good clinical outcome after endovascular therapy ≥ 6-24 h as in DAWN/DEFUSE3 could not be achieved. Similar outcomes are seen in patients selected for EVT ≥ 6 h based on factors other than CTP. Patients triaged without CTP showed trends for shorter arrival to reperfusion times and higher rates of independence.
Sections du résumé
BACKGROUND AND PURPOSE
OBJECTIVE
To provide real-world data on outcome and procedural factors of late thrombectomy patients.
METHODS
METHODS
We retrospectively analyzed patients from the multicenter German Stroke Registry. The primary endpoint was clinical outcome on the modified Rankin scale (mRS) at 3 months. Trial-eligible patients and the subgroups were compared to the ineligible group. Secondary analyses included multivariate logistic regression to identify predictors of good outcome (mRS ≤ 2).
RESULTS
RESULTS
Of 1917 patients who underwent thrombectomy, 208 (11%) were treated within a time window ≥ 6-24 h and met the baseline trial criteria. Of these, 27 patients (13%) were eligible for DAWN and 39 (19%) for DEFUSE3 and 156 patients were not eligible for DAWN or DEFUSE3 (75%), mainly because there was no perfusion imaging (62%; n = 129). Good outcome was not significantly higher in trial-ineligible (27%) than in trial-eligible (20%) patients (p = 0.343). Patients with large trial-ineligible CT perfusion imaging (CTP) lesions had significantly more hemorrhagic complications (33%) as well as unfavorable outcomes.
CONCLUSION
CONCLUSIONS
In clinical practice, the high number of patients with a good clinical outcome after endovascular therapy ≥ 6-24 h as in DAWN/DEFUSE3 could not be achieved. Similar outcomes are seen in patients selected for EVT ≥ 6 h based on factors other than CTP. Patients triaged without CTP showed trends for shorter arrival to reperfusion times and higher rates of independence.
Identifiants
pubmed: 34097080
doi: 10.1007/s00062-021-01033-1
pii: 10.1007/s00062-021-01033-1
pmc: PMC8463374
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
799-810Investigateurs
T Boeckh-Behrens
(T)
S Wunderlich
(S)
A Reich
(A)
M Wiesmann
(M)
U Ernemann
(U)
T Hauser
(T)
E Siebert
(E)
C Nolte
(C)
S Zweynert
(S)
G Bohner
(G)
A Ludolph
(A)
K-H Henn
(KH)
W Pfeilschifter
(W)
M Wagner
(M)
J Röther
(J)
B Eckert
(B)
J Berrouschot
(J)
C Gerloff
(C)
J Fiehler
(J)
G Thomalla
(G)
A Alegiani
(A)
E Hattingen
(E)
G Petzold
(G)
S Thonke
(S)
C Bangard
(C)
C Kraemer
(C)
M Dichgans
(M)
M Psychogios
(M)
J Liman
(J)
M Petersen
(M)
F Stögbauer
(F)
P Kraft
(P)
M Pham
(M)
M Braun
(M)
A Kastrup
(A)
K Gröschel
(K)
T Uphaus
(T)
V Limmroth
(V)
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021. The Author(s).
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