May endovascular thrombectomy without CT perfusion improve clinical outcome?

被引：22

作者：

Alexandre, Andrea M. ^{[1
]}

Pedicelli, Alessandro ^{[1
]}

Valente, Iacopo ^{[1
]}

Scarcia, Luca ^{[1
]}

Giubbolini, Francesca ^{[1
]}

D'Argento, Francesco ^{[1
]}

Lozupone, Emilio ^{[1
]}

Distefano, Marisa ^{[2
]}

Pilato, Fabio ^{[2
]}

Colosimo, Cesare ^{[1
,3
]}

机构：

[1] Fdn Policlin Univ A Gemelli IRCCS, Dipartimento Diagnost Immagini Radioterapia Oncol, UOC Radiol & Neuroradiol, Rome, Italy

[2] Fdn Policlin Univ A Gemelli IRCCS, UOC Neurol, Rome, Italy

[3] Univ Cattolica Sacro Cuore, Ist Radiol, Rome, Italy

来源：

CLINICAL NEUROLOGY AND NEUROSURGERY | 2020年 / 198卷

关键词：

Stroke; Endovascular thrombectomy; CT perfusion; Stroke after 6 hours; Innovative biotechnologies; ISCHEMIC-STROKE; ANGIOGRAPHY; THERAPY; TRIAL; ONSET;

D O I：

10.1016/j.clineuro.2020.106207

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background: DAWN and DEFUSE-3 trials demonstrated the benefit of endovascular thrombectomy in late-presenting acute ischemic strokes due to anterior circulation large vessel occlusion. The aim of our study is to evaluate results of endovascular thrombectomy in large intracranial vessel occlusion without perfusion CT patient selection. Methods: we reviewed our prospectively collected endovascular databases for patients with an acute stroke from March 2016 to October 2018, treated after 6 h from stroke onset, without perfusion CT selection. Baseline characteristics, procedural data, and outcomes were evaluated. A good outcome was defined as a 90-day modified Rankin Scale score of 0-2. The association between clinical and procedural parameters and functional outcome was assessed. Results: out of 212 patients 55 were treated after 6 h from stroke onset, 49 of which for an anterior circulation occlusion. 18/49 were functional independent at 90 days (mRS 0-2), Successful recanalization (mTICI 2b to 3) was achieved in 38/49 patients (77 %). Multivariate logistic regression indicated that a low baseline NIHSS was associated with favorable outcome (OR 0.66, 95 % CI 0.52-0.83, p-value 0.001). Conclusions: in our retrospective analysis, baseline NIHSS is the only parameter that can predict good outcome (90-days mRS 0-2). We confirm data from recent papers assessing that perfusion CT can provide a better patients' selection compared to mCTA for large vessels occlusion treated beyond six hours from symptom onset.

引用

页数：5

共 21 条

[1] Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging [J].

Albers, G. W. ;

Marks, M. P. ;

Kemp, S. ;

Christensen, S. ;

Tsai, J. P. ;

Ortega-Gutierrez, S. ;

McTaggart, R. A. ;

Torbey, M. T. ;

Kim-Tenser, M. ;

Leslie-Mazwi, T. ;

Sarraj, A. ;

Kasner, S. E. ;

Ansari, S. A. ;

Yeatts, S. D. ;

Hamilton, S. ;

Mlynash, M. ;

Heit, J. J. ;

Zaharchuk, G. ;

Kim, S. ;

Carrozzella, J. ;

Palesch, Y. Y. ;

Demchuk, A. M. ;

Bammer, R. ;

Lavori, P. W. ;

Broderick, J. P. ;

Lansberg, M. G. .

NEW ENGLAND JOURNAL OF MEDICINE, 2018, 378 (08) :708-718

[2] Hemorrhagic transformation of ischemic brain tissue -: Asymptomatic or symptomatic? [J].

Berger, C ;

Fiorelli, M ;

Steiner, T ;

Schäbitz, WR ;

Bozzao, L ;

Bluhmki, E ;

Hacke, W ;

von Kummer, R .

STROKE, 2001, 32 (06) :1330-1335

[3] A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke [J].

Berkhemer, O. A. ;

Fransen, P. S. S. ;

Beumer, D. ;

van den Berg, L. A. ;

Lingsma, H. F. ;

Yoo, A. J. ;

Schonewille, W. J. ;

Vos, J. A. ;

Nederkoorn, P. J. ;

Wermer, M. J. H. ;

van Walderveen, M. A. A. ;

Staals, J. ;

Hofmeijer, J. ;

van Oostayen, J. A. ;

Nijeholt, G. J. Lycklama A. ;

Boiten, J. ;

Brouwer, P. A. ;

Emmer, B. J. ;

de Bruijn, S. F. ;

van Dijk, L. C. ;

Kappelle, L. J. ;

Lo, R. H. ;

Van Dijk, E. J. ;

de Vries, J. ;

de Kort, P. L. M. ;

van Rooij, W. J. J. ;

van den Berg, J. S. P. ;

van Hasselt, B. A. A. M. ;

Aerden, L. A. M. ;

Dallinga, R. J. ;

Visser, M. C. ;

Bot, J. C. J. ;

Vroomen, P. C. ;

Eshghi, O. ;

Schreuder, T. H. C. M. L. ;

Heijboer, R. J. J. ;

Keizer, K. ;

Tielbeek, A. V. ;

den Hertog, H. M. ;

Gerrits, D. G. ;

van den Berg-Vos, R. M. ;

Karas, G. B. ;

Steyerberg, E. W. ;

Flach, H. Z. ;

Marquering, H. A. ;

Sprengers, M. E. S. ;

Jenniskens, S. F. M. ;

Beenen, L. F. M. ;

van den Berg, R. ;

Koudstaal, P. J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (01) :11-20

[4] Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection [J].

Campbell, B. C. V. ;

Mitchell, P. J. ;

Kleinig, T. J. ;

Dewey, H. M. ;

Churilov, L. ;

Yassi, N. ;

Yan, B. ;

Dowling, R. J. ;

Parsons, M. W. ;

Oxley, T. J. ;

Wu, T. Y. ;

Brooks, M. ;

Simpson, M. A. ;

Miteff, F. ;

Levi, C. R. ;

Krause, M. ;

Harrington, T. J. ;

Faulder, K. C. ;

Steinfort, B. S. ;

Priglinger, M. ;

Ang, T. ;

Scroop, R. ;

Barber, P. A. ;

McGuinness, B. ;

Wijeratne, T. ;

Phan, T. G. ;

Chong, W. ;

Chandra, R. V. ;

Bladin, C. F. ;

Badve, M. ;

Rice, H. ;

de Villiers, L. ;

Ma, H. ;

Desmond, P. M. ;

Donnan, G. A. ;

Davis, S. M. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1009-1018

[5] Thrombectomy 6-24 hours after stroke in trial ineligible patients [J].

Desai, Shashvat M. ;

Rocha, Marcelo ;

Molyneaux, Bradley J. ;

Starr, Matthew ;

Kenmuir, Cynthia L. ;

Gross, Bradley A. ;

Jankowitz, Brian Thomas ;

Jovin, Tudor G. ;

Jadhav, Ashutosh P. .

JOURNAL OF NEUROINTERVENTIONAL SURGERY, 2018, 10 (11) :1033-1037

[6] Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke [J].

Goyal, M. ;

Demchuk, A. M. ;

Menon, B. K. ;

Eesa, M. ;

Rempel, J. L. ;

Thornton, J. ;

Roy, D. ;

Jovin, T. G. ;

Willinsky, R. A. ;

Sapkota, B. L. ;

Dowlatshahi, D. ;

Frei, D. F. ;

Kamal, N. R. ;

Montanera, W. J. ;

Poppe, A. Y. ;

Ryckborst, K. J. ;

Silver, F. L. ;

Shuaib, A. ;

Tampieri, D. ;

Williams, D. ;

Bang, O. Y. ;

Baxter, B. W. ;

Burns, P. A. ;

Choe, H. ;

Heo, J. -H. ;

Holmstedt, C. A. ;

Jankowitz, B. ;

Kelly, M. ;

Linares, G. ;

Mandzia, J. L. ;

Shankar, J. ;

Sohn, S. -I. ;

Swartz, R. H. ;

Barber, P. A. ;

Coutts, S. B. ;

Smith, E. E. ;

Morrish, W. F. ;

Weill, A. ;

Subramaniam, S. ;

Mitha, A. P. ;

Wong, J. H. ;

Lowerison, M. W. ;

Sajobi, T. T. ;

Hill, M. D. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1019-1030

[7] Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II) [J].

Hacke, W ;

Kaste, M ;

Fieschi, C ;

von Kummer, R ;

Davalos, A ;

Meier, D ;

Larrue, V ;

Bluhmki, E ;

Davis, S ;

Donnan, G ;

Schneider, D ;

Diez-Tejedor, E ;

Trouillas, P .

LANCET, 1998, 352 (9136) :1245-1251

[8] Thrombectomy within 8 Hours after Symptom Onset in Ischemic Stroke [J].

Jovin, T. G. ;

Chamorro, A. ;

Cobo, E. ;

de Miquel, M. A. ;

Molina, C. A. ;

Rovira, A. ;

San Roman, L. ;

Serena, J. ;

Abilleira, S. ;

Ribo, M. ;

Millan, M. ;

Urra, X. ;

Cardona, P. ;

Lopez-Cancio, E. ;

Tomasello, A. ;

Castano, C. ;

Blasco, J. ;

Aja, L. ;

Dorado, L. ;

Quesada, H. ;

Rubiera, M. ;

Hernandez-Perez, M. ;

Goyal, M. ;

Demchuk, A. M. ;

von Kummer, R. ;

Gallofre, M. ;

Davalos, A. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (24) :2296-2306

[9] Comparison of multimodal CT scan protocols used for decision-making on mechanical thrombectomy in acute ischemic stroke [J].

Khumtong, Rujimas ;

Krings, Timo ;

Pereira, Vitor M. ;

Pikula, Aleksandra ;

Schaafsma, Joanna D. .

NEURORADIOLOGY, 2020, 62 (03) :399-406

[10] Computed Tomographic Perfusion to Predict Response to Recanalization in Ischemic Stroke [J].

Lansberg, Maarten G. ;

Christensen, Soren ;

Kemp, Stephanie ;

Mlynash, Michael ;

Mishra, Nishant ;

Federau, Christian ;

Tsai, Jenny P. ;

Kim, Sun ;

Nogueria, Raul G. ;

Jovin, Tudor ;

Devlin, Thomas G. ;

Akhtar, Naveed ;

Yavagal, Dileep R. ;

Haussen, Diogo ;

Dehkharghani, Seena ;

Bammer, Roland ;

Straka, Matus ;

Zaharchuk, Greg ;

Marks, Michael P. ;

Albers, Gregory W. .

ANNALS OF NEUROLOGY, 2017, 81 (06) :849-856

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