Abstract
Abstract 112: Identifying Patients Who May Benefit From Thrombectomy in the Late Time Window: Predictors of Good Outcome Beyond Advanced Imaging
Stroke (1970), v 49(Suppl_1)
22 Jan 2018
Abstract
Abstract only
Background:
The DAWN trial showed EVT effectiveness in the late time window (6-24 hrs), however, DAWN patients were carefully selected based on advanced perfusion imaging, CTP and MRI. Similar to the early window (0-6 hrs), simple imaging (CT) and other clinical variables may select patients for thrombectomy beyond 6 hours. We evaluated a largescale, real world practice for predictors that could identify patients who may benefit from EVT in the late time window.
Methods:
Patients with LVO in the anterior circulation (M1, M2, ICA) from a prospective, single arm, multicenter, international registry (Trevo Retriever Registry) treated in the late window LSN to groin puncture (GP) (6-24 hrs) were included. Univariate and multivariate analyses assessed factors independently correlating with good outcome (90 day mRS 0-2). Furthermore, patients outcomes were compared based on their baseline imaging selection CT vs CTP and MRI.
Results:
549 patients were treated beyond 6 hours. The average age was 67, median/IQR ASPECTS 8(6-9), median/IQR NIHSS was 15 (9-20), median/IQR time LSN to GP (hr) was 9.7 (7.3-13.6) and IV-tPA rate were 22.8%. CT was the only imaging selection method in 15.9%, while additional advanced imaging was utilized in the remaining patients; CTP (70%), and MRI(14.1%). Good outcomes were observed in 51.4% of late window patients. Age (aOR 0.96, 95% CI 0.94-0.98, p<0.001), stroke severity by NIHSS (aOR 0.9, 95% CI 0.86-0.95, p<0.001) and ASPECTS (for each point increment in ASPECTS aOR 1.24, 95% CI 1.05-1.47, p=0.012) were independent pre-intervention predictors of good outcome in the late window. The addition of advanced imaging beyond CT, including CTP or MRI, did not confer higher correlation with good outcome (aOR 1.45, 95% CI 0.77-2.73, p=0.25). Good outcome was achieved in 56% of CT selected patients as compared to 53% patients selected by CTP or MRI.
Conclusion:
Simple imaging and clinical variables can identify patients that could benefit from thrombectomy in the late window. Importantly, ASPECTS reliably predicted good outcome beyond 6 hours without adjunctive benefit from adding advanced perfusion imaging, a finding that may simplify patients selection to facilitate and generalize the intervention in the late window to wide, real world practice.
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Details
- Title
- Abstract 112: Identifying Patients Who May Benefit From Thrombectomy in the Late Time Window: Predictors of Good Outcome Beyond Advanced Imaging
- Creators
- Amrou Sarraj - The University of Texas Health Science Center at HoustonRaul Nogueira - Grady Memorial HospitalDavid S Liebeskind - Core LaboratoriesRonald Budzik - Riverside Methodist HospitalChristine M Farrell - The University of Texas Health Science Center at HoustonJoey English - California Pacific Medical CenterBlaise Baxter - Erlanger Health SystemBruno Bartolini - Pitié-Salpêtrière HospitalAntonin Krajina - University of Hradec KrálovéAmeer Hassan - Valley Baptist Medical CenterErol Veznedaroglu - Neurosciences InstituteRyan Shields - StrykerYanchang Zhang - StrykerSean Savitz - The University of Texas Health Science Center at HoustonLouise McCullough - The University of Texas Health Science Center at HoustonAli Malek - St. Mary's Medical CenterNirav A Vora - Riverside Methodist HospitalMichael Chen - Rush UniversityRishi Gupta - WellStar Health SystemTrevo Retriever Registry Investigators
- Publication Details
- Stroke (1970), v 49(Suppl_1)
- Resource Type
- Abstract
- Language
- English
- Academic Unit
- Neurosurgery
- Other Identifier
- 991021962191904721