Safety of endovascular treatment beyond the 6‐h time window in 205 patients. Issue 6 (7th January 2013)

• Record Type: Journal Article
• Authors: Jung, S.; Gralla, J.; Fischer, U.; Mono, M.‐L.; Weck, A.; Lüdi, R.; Heldner, M. R.; Findling, O.; El‐Koussy, M.; Brekenfeld, C.; Schroth, G.; Mattle, H. P.; Arnold, M.
• Is Part Of: European journal of neurology. Volume 20:Issue 6(2013:Jun.)
• Page Start: 865
• Page End: 871
• Publication Date: 2013-01-07
• Subjects: Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ene.12069
• Languages: English
• ISSNs: 1351-5101

Abstract

<abstract abstract-type="main" xml:lang="en" id="ene12069-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ene12069-sec-0001" sec-type="section"> <title>Background and purpose</title> <p>Intra‐arterial treatment (IAT) is effective when performed within 6 h of symptom onset in selected stroke patients ('T < 6H'). Its safety and efficacy is unclear when the patient has had symptoms for more than 6 h ('T > 6H') or for an unknown time (unclear‐onset stroke, UOS), or woke up with a stroke (wake‐up stroke, WUS). In this study we compared the safety of IAT in these four patient groups.</p> </sec> <sec id="ene12069-sec-0002" sec-type="section"> <title>Methods</title> <p>Eight‐hundred and fifty‐nine patients treated with IAT were enrolled. The main outcome parameters were clinical outcome [excellent: modified Rankin Scale (mRS) 0 or 1; or favorable: mRS 0–2] or mortality 3 months after treatment. Further outcome parameters were the rates of vessel recanalization, and cerebral and systemic hemorrhage.</p> </sec> <sec id="ene12069-sec-0003" sec-type="section"> <title>Results</title> <p>Six‐hundred and fifty‐four patients were treated before (T < 6H) and 205 after 6 h or an unknown time (128 T > 6H, 55 WUS and 22 UOS). NIHSS scores were higher in UOS patients than in T < 6H patients, vertebrobasilar occlusion was more common in T > 6H and UOS patients, and middle cerebral artery occlusions less common in T > 6H than in T < 6H patients. Other baseline characteristics were similar. There was no significant difference in clinical outcome and the rate of hemorrhage in multivariable regression analysis.</p> </sec> <sec id="ene12069-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Clinical outcome of our four groups of patients was similar with no increase of hemorrhage rates in patients treated after awakening, after an unknown time or more than 6 h. Our preliminary data suggest that treatment of such patients may be performed safely. If confirmed in randomized trials, this would have major clinical implications.</p> </sec> </abstract>