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KMID : 1142120230250030378
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Journal of Stroke
2023 Volume.25 No. 3 p.378 ~ p.387
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Clinical and Safety Outcomes of Endovascular Therapy 6 to 24 Hours After Large Vessel Occlusion Ischemic Stroke With Tandem Lesions
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Milagros Galecio-Castillo
Mudassir Farooqui
Ameer E. Hassan
Mouhammad A. Jumaa
Afshin A. Divani
Marc Ribo
Michael Abraham
Nils H. Petersen
Johanna T. Fif
Waldo R. Guerrero
Amer M. Malik
James E. Siegler
Thanh N. Nguyen
Sunil Sheth
Albert J. Yoo
Guillermo Linares
Nazli Janjua
Darko Quispe-Orozco
Wondwossen Tekle
Syed F. Zaidi
Sara Y. Sabbagh
Marta Olive-Gadea
Tiffany Barkley
Reade De Leacy
Kenyon W. Sprankle
Mohamad Abdalkader
Sergio Salazar-Marioni
Jazba Soomro
Weston Gordon
Charoskhon Turabova
Juan Vivanco-Suarez
Shunmin Wang
Maxim Mokin
Dileep R. Yavagal
Zixiu Bian
Santiago Ortega-Gutierrez
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Abstract
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Background and Purpose : Effect of endovascular therapy (EVT) in acute large vessel occlusion (LVO) patients with tandem lesions (TLs) within 6-24 hours after last known well (LKW) remains unclear. We evaluated the clinical and safety outcomes among TL-LVO patients treated within 6-24 hours.
Methods : This multicenter cohort was divided into two groups, based on LKW to puncture time: early window (<6 hours), and late window (6-24 hours). Primary clinical and safety outcomes were 90-day functional independence measured by the modified Rankin Scale (mRS: 0-2) and symptomatic intracranial hemorrhage (sICH). Secondary outcomes were successful reperfusion (modified Thrombolysis in Cerebral Infarction score ≥2b), first-pass effect, early neurological improvement, ordinal mRS, and in-hospital and 90-day mortality.
Results : Of 579 patients (median age 68, 32.1% females), 268 (46.3%) were treated in the late window and 311 (53.7%) in the early window. Late window group had lower median National Institutes of Health Stroke Scale score at admission, Alberta Stroke Program Early Computed Tomography Score, rates of intravenous thrombolysis, and higher rates for perfusion imaging. After adjusting for confounders, the odds of 90-day mRS 0-2 (47.7% vs. 45.0%, adjusted odds ratio [aOR] 0.71, 95% confidence interval [CI] 0.49-1.02), favorable shift in mRS (aOR 0.88, 95% CI 0.44-1.76), and sICH (3.7% vs. 5.2%, aOR 0.56, 95% CI 0.20-1.56) were similar in both groups. There was no difference in secondary outcomes. Increased time from LKW to puncture did not predicted the probability of 90-day mRS 0-2 (aOR 0.99, 95% CI 0.96-1.01, for each hour delay) among patients presenting <24 hours.
Conclusion : EVT for acute TL-LVO treated within 6-24 hours after LKW was associated with similar rates of clinical and safety outcomes, compared to patients treated within 6 hours.
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KEYWORD
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Ischemic stroke, Carotid artery diseases, Tandem lesions, Thrombectomy, Early window, Late window
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