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Mechanical Thrombectomy Up to 24Hours in Large Vessel Occlusions and Infarct Velocity Assessment. Journal of the American Heart Association Inoue, M., Yoshimoto, T., Tanaka, K., Koge, J., Shiozawa, M., Nishii, T., Ohta, Y., Fukuda, T., Satow, T., Kataoka, H., Yamagami, H., Ihara, M., Koga, M., Mlynash, M., Albers, G. W., Toyoda, K. 2021: e022880

Abstract

Background We retrospectively compared early- (<6hours) versus late- (6-24hours) presenting patients using perfusion-weighted imaging selection and evaluated clinical/radiographic outcomes. Methods and Results Large vessel occlusion patients treated with mechanical thrombectomy from August 2017 to July 2020 within 24hours of onset were retrieved from a single-center database. Perfusion-weighted imaging was analyzed by automated software and final infarct volume was measured semi-automatically within 14days. The primary end point was good outcome (modified Rankin Scale 0-2 at 90days). Secondary end points were excellent outcome (modified Rankin Scale 0-1 at 90days), symptomatic intracranial hemorrhage, and death. Clinical characteristics/radiological values including hypoperfusion volume and infarct growth velocity (baseline volume/onset-to-image time) were compared between the groups. Of 1294 patients, 118 patients were included. The median age was 74years, baseline National Institutes of Health Stroke Scale score was 14, and core volume was 13mL. The late-presenting group had more female patients (67% versus 31%, respectively; P=0.001). No statistically significant differences were seen in good outcome (42% versus 53%, respectively; P=0.30), excellent outcome (26% versus 32%, respectively; P=0.51), symptomatic intracranial hemorrhage (6.5% versus 4.6%, respectively; P=0.74), and death (3.2% versus 5.7%, respectively; P=0.58) between the groups. The late-presenting group had more atherothrombotic cerebral infarction (19% versus 6%, respectively; P=0.03), smaller hypoperfusion volume (median: 77 versus 133mL, respectively; P=0.04), and slower infarct growth velocity (median: 0.6 versus 5.1mL/h, respectively; P=0.03). Conclusions Patients with early- and late-time windows treated with mechanical thrombectomy by automated perfusion-weighted imaging selection have similar outcomes, comparable with those in randomized trials, but different in infarct growth velocities. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02251665.

View details for DOI 10.1161/JAHA.121.022880

View details for PubMedID 34889115