Abstract
Endovascular treatment (EVT) has been accepted as the standard of care for patients with acute ischemic stroke. The aim of the present study was to compare clinical outcomes of patients who received EVT within and beyond 6 h from symptom onset to groin puncture without perfusion software in Guangdong district, China. Between March 2017 and May 2018, acute ischemic stroke patients who received EVT from 6 comprehensive stroke centers, were enrolled into the registry study. In this subgroup study, we included all patients who had acute proximal large vessel occlusion in the anterior circulation. The demographic, clinical and neuroimaging data were collected from each center. A total of 192 patients were included in this subgroup study. They were divided into two groups: group A (n = 125), within 6 h; group B (n = 67), 6–24 h from symptom onset to groin puncture. There were no substantial differences between these two groups in terms of 90 days favorable outcome (modified Rankin scale [mRS] ≤ 2, P = 0.051) and mortality (P = 0.083), and the risk of symptomatic intracranial hemorrhage at 24 h (P = 0.425). The NIHSS (median 16, IQR12-20, group A; median 12, IQR8-18, group B; P = 0.009) and ASPECTS (median 10, IQR8-10, group A; median 9, IQR8-10, group B; P = 0.034) at baseline were higher in group A. The anesthesia method (general anesthesia, 21.3%, group A vs. 1.5% group B, P = 0.001) were also statistically different between the two groups. The NIHSS and ASPECTS were higher, and general anesthesia was also more widely used in group A. Clinical outcomes were not significantly different within 6 h versus 6–24 h from symptom onset to groin puncture in this real world study.
Highlights
Endovascular treatment (EVT) has been accepted as the standard of care for patients with acute ischemic stroke
Mortality and symptomatic intracranial hemorrhage (SICH) and 90-day favorable outcome of patients in both two groups were not significantly different in the present real world study. These results suggesting that the prolonged time window for patients undergoing EVT present with favorable and safety clinical outcome when compared to patients treated within 6 h
MR CLEAN Registry study have revealed that every hour of delay in time from onset to the start of EVT resulted in a 5.3% decrease in probability of functional independence[19]
Summary
Endovascular treatment (EVT) has been accepted as the standard of care for patients with acute ischemic stroke. The decline in treatment effect appears to be strongly influenced by patient selection, and the concept of faster reperfusion is associated with better outcomes after the EVT has been challenged These RCTs provide significant guidance in clinical practice for treating acute ischemic stroke patients. In clinical practice in Guangdong district in China, EVT patients are selected mainly based on the NIHSS score, onset time, ASPECTS, and conventional CT or MR mismatch without calculated. Whether this selection criteria will benefit patients is unclear, especially for patients beyond 6 h. Conducting a real world study in Guangdong district in China would be more meaningful
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