Endovascular Thrombectomy for Acute Ischemic Stroke Beyond 6 Hours From Onset A Real-World Experience

被引：55

作者：

Casetta, Ilaria ^{[1
]}

Fainardi, Enrico ^{[2
]}

Saia, Valentina ^{[3
]}

Pracucci, Giovanni ^{[5
]}

Padroni, Marina ^{[1
]}

Renieri, Leonardo ^{[4
]}

Nencini, Patrizia ^{[5
]}

Inzitari, Domenico ^{[5
]}

Morosetti, Daniele ^{[6
]}

Sallustio, Fabrizio ^{[7
]}

Vallone, Stefano ^{[8
]}

Bigliardi, Guido ^{[9
]}

Zini, Andrea ^{[10
]}

Longo, Marcello ^{[11
]}

Francalanza, Isabella ^{[12
]}

Bracco, Sandra ^{[13
]}

Vallone, Ignazio M. ^{[13
]}

Tassi, Rossana ^{[14
]}

Bergui, Mauro ^{[15
]}

Naldi, Andrea ^{[16
]}

Saletti, Andrea ^{[17
]}

De Vito, Alessandro ^{[18
]}

Gasparotti, Roberto ^{[19
]}

Magoni, Mauro ^{[61
]}

Castellan, Lucio ^{[20
]}

Serrati, Carlo ^{[21
]}

Menozzi, Roberto ^{[22
]}

Scoditti, Umberto ^{[23
]}

Causin, Francesco ^{[24
]}

Pieroni, Alessio ^{[25
,26
]}

Puglielli, Edoardo ^{[27
]}

Casalena, Alfonsina ^{[28
]}

Sanna, Antioco ^{[29
]}

Ruggiero, Maria ^{[29
]}

Cordici, Francesco ^{[30
]}

Di Maggio, Luca ^{[31
]}

Duc, Enrica ^{[32
]}

Cosottini, Mirco ^{[33
]}

Giannini, Nicola ^{[34
]}

Sanfilippo, Giuseppina ^{[35
]}

Zappoli, Federico ^{[35
]}

Cavallini, Anna ^{[28
,37
]}

Cavasin, Nicola ^{[36
]}

Critelli, Adriana ^{[37
]}

Ciceri, Elisa ^{[38
]}

Plebani, Mauro ^{[38
]}

Cappellari, Manuel ^{[39
]}

Chiumarulo, Luigi ^{[40
]}

Petruzzellis, Marco ^{[41
]}

Terrana, Alberto ^{[42
]}

机构：

[1] Univ Ferrara, Clin Neurol, Via Aldo Moro 8, I-44124 Cona Ferrara, Italy

[2] Univ Florence, Neuroradiol Unit, Florence, Italy

[3] Santa Corona Hosp, Stroke Unit, Pietra Ligure, Italy

[4] Careggi Univ Hosp, Intervent Neuroradiol Unit, Florence, Italy

[5] Careggi Univ Hosp, Stroke Unit, Florence, Italy

[6] Univ Roma Tor Vergata, Diagnost Imaging & Intervent Radiol Unit, Rome, Italy

[7] Univ Roma Tor Vergata, Stroke Unit, Rome, Italy

[8] Osped Civile S Agostino Estense, AOU Modena, Intervent Neuroradiol Unit, Modena, Italy

[9] Osped Civile S Agostino Estense, AOU Modena, Stroke Unit, Modena, Italy

[10] Maggiore Hosp, Neurol & Stroke Unit, Bologna, Italy

[11] Policlin G Martino, Intervent Neuroradiol Unit, Messina, Italy

[12] Policlin G Martino, Stroke Unit, Messina, Italy

[13] AOU Senese, Neuroimaging & Neurointervent Unit NINT, Siena, Italy

[14] Univ Hosp S Maria delle Scotte, Stroke Unit, Siena, Italy

[15] Citta Salute & Sci Molinette, Intervent Neuroradiol Unit, Turin, Italy

[16] Univ Turin, Dept Neurosci Rita Levi Montalcini, Turin, Italy

[17] Univ Hosp Arcispedale S Anna, Intervent Neuroradiol Unit, Ferrara, Italy

[18] Univ Hosp Arcispedale S Anna, Stroke Unit, Ferrara, Italy

[19] Spedali Civil Brescia, Intervent Neuroradiol Unit, Brescia, Italy

[20] IRCCS San Martino IST, Intervent Neuroradiol Unit, Genoa, Italy

[21] IRCCS San Martino IST, Neurol & Stroke Unit, Genoa, Italy

[22] Univ Hosp, Intervent Neuroradiol Unit, Parma, Italy

[23] Univ Hosp, Stroke Unit, Parma, Italy

[24] Padua Univ Hosp, Neuroradiol Unit, Padua, Italy

[25] Padua Univ Hosp, Stroke Unit, Padua, Italy

[26] Padua Univ Hosp, Neurosonol Lab, Padua, Italy

[27] Osped Civile Mazzini, Vasc & Intervent Radiol Unit, Teramo, Italy

[28] Osped Civile Mazzini, Neurol Unit, Teramo, Italy

[29] AUSL Romagna, M Bufalini Hosp, Neuroradiol Unit, Cesena, Italy

[30] AUSL Romagna, M Bufalini Hosp, Neurol Unit, Cesena, Italy

[31] San Giovanni Bosco Hosp, Intervent Radiol & Neuroradiol Unit, Turin, Italy

[32] San Giovanni Bosco Hosp, Neurol Unit, Turin, Italy

[33] AOU Pisa, Neuroradiol Unit, Pisa, Italy

[34] AOU Pisa, Neurol Unit, Pisa, Italy

[35] Policlin IRCCS San Matteo, Diagnost & Intervent Neuroradiol Unit, Pavia, Italy

[36] Osped Angelo USSL3 Serenissima, Neuroradiol Unit, Venice, Italy

[37] Osped Angelo USSL3 Serenissima, Neurol Unit, Venice, Italy

[38] AOUI Verona, Neuroradiol Unit, Verona, Italy

[39] AOUI Verona, Neurol Unit, Verona, Italy

[40] Policlin Bari, Intervent Neuroradiol Unit, Bari, Italy

[41] Policlin Bari, Stroke Unit, Bari, Italy

[42] ASST Settelaghi, AOU Circolo, Neuroradiol Unit, Varese, Italy

[43] ASST Settelaghi, AOU Circolo, Neurol & Stroke Unit, Varese, Italy

[44] Osped SS Annunziata, Intervent Radiol, Taranto, Italy

[45] Osped SS Annunziata, Stroke Unit, Taranto, Italy

[46] AO Annunziata, Intervent Neuroradiol Unit, Cosenza, Italy

[47] Policlin Umberto 1, Intervent Neuroradiol Unit, Rome, Italy

[48] Sapienza Univ Hosp, Emergency Dept, Stroke Unit, Rome, Italy

[49] S Corona Hosp, ASL2 Savonese, Neuroradiol Unit, Pietra Ligure, Italy

[50] S Corona Hosp, ASL2 Savonese, Neurol & Stroke Unit, Pietra Ligure, Italy

来源：

STROKE | 2020年 / 51卷 / 07期

关键词：

cerebral blood volume; collateral circulation; groin; intracranial hemorrhage; middle cerebral artery; thrombectomy; ANTERIOR CIRCULATION STROKE; TIME WINDOW; MECHANICAL THROMBECTOMY; INTRAVENOUS ALTEPLASE; CT ANGIOGRAPHY; PERFUSION; OUTCOMES; THERAPY; TRIAL; GUIDELINES;

D O I：

10.1161/STROKEAHA.119.027974

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose: To evaluate outcome and safety of endovascular treatment beyond 6 hours of onset of ischemic stroke due to large vessel occlusion in the anterior circulation, in routine clinical practice. Methods: From the Italian Registry of Endovascular Thrombectomy, we extracted clinical and outcome data of patients treated for stroke of known onset beyond 6 hours. Additional inclusion criteria were prestroke modified Rankin Scale score <= 2 and ASPECTS score >= 6. Patients were selected on individual basis by a combination of CT perfusion mismatch (difference between total hypoperfusion and infarct core sizes) and CT collateral score. The primary outcome measure was the score on modified Rankin Scale at 90 days. Safety outcomes were 90-day mortality and the occurrence of symptomatic intracranial hemorrhage. Data were compared with those from patients treated within 6 hours. Results: Out of 3057 patients, 327 were treated beyond 6 hours. Their mean age was 66.8 +/- 14.9 years, the median baseline National Institutes of Health Stroke Scale 16, and the median onset to groin puncture time 430 minutes. The most frequent site of occlusion was middle cerebral artery (45.1%). Functional independence (90-day modified Rankin Scale score, 0-2) was achieved by 41.3% of cases. Symptomatic intracranial hemorrhage occurred in 6.7% of patients, and 3-month case fatality rate was 17.1%. The probability of surviving with modified Rankin Scale score, 0-2 (odds ratio, 0.58 [95% CI, 0.43-0.77]) was significantly lower in patients treated beyond 6 hours as compared with patients treated earlier No differences were found regarding recanalization rates and safety outcomes between patients treated within and beyond 6 hours. There were no differences in outcome between people treated 6-12 hours from onset (278 patients) and those treated 12 to 24 hours from onset (49 patients). Conclusions: This real-world study suggests that in patients with large vessel occlusion selected on the basis of CT perfusion and collateral circulation assessment, endovascular treatment beyond 6 hours is feasible and safe with no increase in symptomatic intracranial hemorrhage.

引用

页码：2051 / 2057

页数：7

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