Journal of Stroke (May 2024)
Endovascular Therapy in the Extended Time Window for Large Vessel Occlusion in Patients With Pre-Stroke Disability
- Kanta Tanaka,
- Hiroshi Yamagami,
- Muhammad M. Qureshi,
- Kazutaka Uchida,
- James E. Siegler,
- Raul G. Nogueira,
- Shinichi Yoshimura,
- Nobuyuki Sakai,
- Nicolas Martinez-Majander,
- Simon Nagel,
- Jelle Demeestere,
- Volker Puetz,
- Diogo C. Haussen,
- Mohamad Abdalkader,
- Marta Olive-Gadea,
- Mahmoud H. Mohammaden,
- João Pedro Marto,
- Anne Dusart,
- Simon Winzer,
- Liisa Tomppo,
- Francois Caparros,
- Hilde Henon,
- Flavio Bellante,
- João Nuno Ramos,
- Santiago Ortega-Gutierrez,
- Sunil A. Sheth,
- Stefania Nannoni,
- Johannes Kaesmacher,
- Lieselotte Vandewalle,
- Sergio Salazar-Marioni,
- Mudassir Farooqui,
- Pekka Virtanen,
- Rita Ventura,
- Syed Zaidi,
- Alicia C. Castonguay,
- Ajit S. Puri,
- Behzad Farzin,
- Hesham E. Masoud,
- Piers Klein,
- Jessica Jesser,
- Manuel Requena,
- Tomas Dobrocky,
- Daniel P.O. Kaiser,
- Erno Peltola,
- Davide Strambo,
- Markus A. Möhlenbruch,
- Eugene Lin,
- Peter A. Ringleb,
- Osama O. Zaidat,
- Charlotte Cordonnier,
- Daniel Roy,
- Robin Lemmens,
- Marc Ribo,
- Daniel Strbian,
- Urs Fischer,
- Patrik Michel,
- Jean Raymond,
- Thanh N. Nguyen
Affiliations
- Kanta Tanaka
- Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan
- Hiroshi Yamagami
- Division of Stroke Prevention and Treatment, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
- Muhammad M. Qureshi
- Department of Radiology, Radiation Oncology, Boston Medical Center, Boston, MA, USA
- Kazutaka Uchida
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
- James E. Siegler
- Department of Neurology, University of Chicago, Chicago, IL, USA
- Raul G. Nogueira
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
- Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical General Hospital, Kobe, Japan
- Nicolas Martinez-Majander
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Simon Nagel
- Department of Neurology, Klinikum Ludwigshafen, Heidelberg University Hospital, Ludwigshafen, Germany
- Jelle Demeestere
- Department of Neurology, Leuven University Hospital, Leuven, Belgium
- Volker Puetz
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Diogo C. Haussen
- Department of Neurology, Grady Memorial Hospital, Atlanta, GA, USA
- Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Marta Olive-Gadea
- Department of Neurology, Hospital Vall d’Hebron, Barcelona, Spain
- Mahmoud H. Mohammaden
- Department of Neurology, Grady Memorial Hospital, Atlanta, GA, USA
- João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
- Anne Dusart
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
- Simon Winzer
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Liisa Tomppo
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Francois Caparros
- Department of Neurology, Centre Hospitalier Universitaire de Lille, University of Lille, Lille, France
- Hilde Henon
- Department of Neurology, Centre Hospitalier Universitaire de Lille, University of Lille, Lille, France
- Flavio Bellante
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium
- João Nuno Ramos
- Department of Neuroradiology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
- Santiago Ortega-Gutierrez
- Department of Neurology, University of Iowa, Iowa City, IA, USA
- Sunil A. Sheth
- Department of Neurology, UTHealth Houston, Houston, TX, USA
- Stefania Nannoni
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, University of Bern, Bern, Switzerland
- Lieselotte Vandewalle
- Department of Neurology, Leuven University Hospital, Leuven, Belgium
- Sergio Salazar-Marioni
- Department of Neurology, UTHealth Houston, Houston, TX, USA
- Mudassir Farooqui
- Department of Neurology, University of Iowa, Iowa City, IA, USA
- Pekka Virtanen
- Department of Radiology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Rita Ventura
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
- Syed Zaidi
- Department of Neurology, University of Toledo, Toledo, OH, USA
- Alicia C. Castonguay
- Department of Neurology, University of Toledo, Toledo, OH, USA
- Ajit S. Puri
- Division of Interventional Neuroradiology, University of Massachusetts Memorial Medical Center, Worcester, MA, USA
- Behzad Farzin
- Department of Radiology, Centre Hospitalier de l’Universite de Montreal, Montreal, Canada
- Hesham E. Masoud
- Department of Neurology, State University of New York, Upstate Medical University, Syracuse, NY, USA
- Piers Klein
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Jessica Jesser
- Department of Radiology, Heidelberg University Hospital, Heidelberg, Germany
- Manuel Requena
- Department of Neurology, Hospital Vall d’Hebron, Barcelona, Spain
- Tomas Dobrocky
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, University of Bern, Bern, Switzerland
- Daniel P.O. Kaiser
- Department of Diagnostic and Interventional Neuroradiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Erno Peltola
- Department of Radiology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Davide Strambo
- Department of Neurology, Lausanne University Hospital, Lausanne, Switzerland
- Markus A. Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
- Eugene Lin
- Neuroscience and Stroke Program, Bon Secours Mercy Health St. Vincent Hospital, Toledo, OH, USA
- Peter A. Ringleb
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
- Osama O. Zaidat
- Neuroscience and Stroke Program, Bon Secours Mercy Health St. Vincent Hospital, Toledo, OH, USA
- Charlotte Cordonnier
- Department of Neurology, Centre Hospitalier Universitaire de Lille, University of Lille, Lille, France
- Daniel Roy
- Department of Radiology, Centre Hospitalier de l’Universite de Montreal, Montreal, Canada
- Robin Lemmens
- Department of Neurology, Leuven University Hospital, Leuven, Belgium
- Marc Ribo
- Department of Neurology, Hospital Vall d’Hebron, Barcelona, Spain
- Daniel Strbian
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Urs Fischer
- Department of Neurology, University Hospital Basel, Switzerland
- Patrik Michel
- Department of Neurology, Lausanne University Hospital, Lausanne, Switzerland
- Jean Raymond
- Department of Radiology, Centre Hospitalier de l’Universite de Montreal, Montreal, Canada
- Thanh N. Nguyen
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- DOI
- https://doi.org/10.5853/jos.2023.04259
- Journal volume & issue
-
Vol. 26,
no. 2
pp. 269 – 279
Abstract
Background and Purpose We compared the outcomes of endovascular therapy (EVT) in an extended time window in patients with large-vessel occlusion (LVO) between patients with and without pre-stroke disability. Methods In this prespecified analysis of the multinational CT for Late Endovascular Reperfusion study (66 participating sites, 10 countries between 2014 and 2022), we analyzed data from patients with acute ischemic stroke with a pre-stroke modified Rankin Scale (mRS) score of 0–4 and LVO who underwent EVT 6–24 hours from the time last seen well. The primary outcome was the composite of functional independence (FI; mRS score 0–2) or return to the pre-stroke mRS score (return of Rankin, RoR) at 90 days. Outcomes were compared between patients with pre-stroke disability (pre-stroke mRS score 2–4) and those without (mRS score 0–1). Results A total of 2,231 patients (median age, 72 years; median National Institutes of Health Stroke Scale score, 16) were included in the present analysis. Of these, 564 (25%) had pre-stroke disability. The primary outcome (FI or RoR) was observed in 30.7% of patients with pre-stroke disability (FI, 16.5%; RoR, 30.7%) compared to 44.1% of patients without (FI, 44.1%; RoR, 13.0%) (P<0.001). In multivariable logistic regression analysis with inverse probability of treatment weighting, pre-stroke disability was not associated with significantly lower odds of achieving FI or RoR (adjusted odds ratio 0.73, 95% confidence interval 0.43–1.25). Symptomatic intracranial hemorrhage occurred in 6.3% of both groups (P=0.995). Conclusion A considerable proportion of patients with late-presenting LVO and pre-stroke disability regained pre-stroke mRS scores after EVT. EVT may be appropriate for patients with pre-stroke disability presenting in the extended time window.
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