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Safety and clinical outcomes of endovascular therapy versus medical management in late presentation of large ischemic stroke

Introduction: The benefit of endovascular therapy (EVT) among stroke patients with large ischemic core (ASPECTS 0-5) in the extended time window outside of trial settings remains unclear. We analyzed the effect of EVT among these stroke patients in real-world settings. - Patients and methods: The CT...

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Main Authors: Mujanović, Adnan (Author) , Strbian, Daniel (Author) , Demeestere, Jelle (Author) , Marto, João Pedro (Author) , Puetz, Volker (Author) , Nogueira, Raul G (Author) , Abdalkader, Mohamad (Author) , Nagel, Simon (Author) , Raymond, Jean (Author) , Ribo, Marc (Author) , Michel, Patrik (Author) , Yoshimura, Shinichi (Author) , Zaidat, Osama O (Author) , Winzer, Simon (Author) , Ortega-Gutierrez, Santiago (Author) , Sheth, Sunil A (Author) , Siegler, James E (Author) , Dusart, Anne (Author) , Haussen, Diogo C (Author) , Henon, Hilde (Author) , Serrallach, Bettina L (Author) , Mohammaden, Mahmoud H (Author) , Möhlenbruch, Markus Alfred (Author) , Olive-Gadea, Marta (Author) , Puri, Ajit S (Author) , Sakai, Nobuyuki (Author) , Klein, Piers (Author) , Tomppo, Liisa (Author) , Caparros, Francois (Author) , Ramos, João Nuno (Author) , Jumaa, Mouhammad (Author) , Zaidi, Syed (Author) , Dobrocky, Tomas (Author) , Martinez-Majander, Nicolas (Author) , Nannoni, Stefania (Author) , Bellante, Flavio (Author) , Rodriguez-Calienes, Aaron (Author) , Salazar-Marioni, Sergio (Author) , Virtanen, Pekka (Author) , Kaiser, Daniel PO (Author) , Ventura, Rita (Author) , Jesser, Jessica (Author) , Castonguay, Alicia C (Author) , Qureshi, Muhammad M (Author) , Masoud, Hesham E (Author) , Galecio-Castillo, Milagros (Author) , Requena, Manuel (Author) , Lauha, Riikka (Author) , Hu, Wei (Author) , Lin, Eugene (Author) , Miao, Zhongrong (Author) , Roy, Daniel (Author) , Yamagami, Hiroshi (Author) , Seiffge, David J (Author) , Strambo, Davide (Author) , Ringleb, Peter A (Author) , Lemmens, Robin (Author) , Fischer, Urs (Author) , Nguyen, Thanh N (Author) , Kaesmacher, Johannes (Author)
Format: Article (Journal)
Language:English
Published: May 17, 2024
In: European stroke journal
Year: 2024, Volume: 9, Issue: 4, Pages: 907-917
ISSN:2396-9881
DOI:10.1177/23969873241249406
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1177/23969873241249406
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Author Notes:Adnan Mujanovic, Daniel Strbian, Jelle Demeestere, João Pedro Marto, Volker Puetz, Raul G Nogueira, Mohamad Abdalkader, Simon Nagel, Jean Raymond, Marc Ribo, Patrik Michel, Shinichi Yoshimura, Osama O Zaidat, Simon Winzer, Santiago Ortega-Gutierrez, Sunil A Sheth, James E Siegler, Anne Dusart, Diogo C Haussen, Hilde Henon, Bettina L Serrallach, Mahmoud H Mohammaden, Markus A Möhlenbruch, Marta Olive-Gadea, Ajit S Puri, Nobuyuki Sakai, Piers Klein, Liisa Tomppo, Francois Caparros, João Nuno Ramos, Mouhammad Jumaa, Syed Zaidi, Tomas Dobrocky, Nicolas Martinez-Majander, Stefania Nannoni, Flavio Bellante, Aaron Rodriguez-Calienes, Sergio Salazar-Marioni, Pekka Virtanen, Daniel PO Kaiser, Rita Ventura, Jessica Jesser, Alicia C Castonguay, Muhammad M Qureshi, Hesham E Masoud, Milagros Galecio-Castillo, Manuel Requena, Riikka Lauha, Wei Hu, Eugene Lin, Zhongrong Miao, Daniel Roy, Hiroshi Yamagami, David J Seiffge, Davide Strambo, Peter A Ringleb, Robin Lemmens, Urs Fischer, Thanh N Nguyen, and Johannes Kaesmacher
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Summary:Introduction: The benefit of endovascular therapy (EVT) among stroke patients with large ischemic core (ASPECTS 0-5) in the extended time window outside of trial settings remains unclear. We analyzed the effect of EVT among these stroke patients in real-world settings. - Patients and methods: The CT for Late Endovascular Reperfusion (CLEAR) study recruited patients from 66 centers in 10 countries between 01/2014 and 05/2022. The extended time-window was defined as 6-24 h from last-seen-well to treatment. The primary outcome was shift of the 3-month modified Rankin scale (mRS) score. Safety outcomes included symptomatic intracranial hemorrhage (sICH) and mortality. Outcomes were analyzed with ordinal and logistic regressions. - Results: Among 5098 screened patients, 2451 were included in the analysis (median age 73, 55% women). Of patients with ASPECTS 0-5 (n = 310), receiving EVT (n = 209/310) was associated with lower 3-month mRS when compared to medical management (median 4 IQR 3-6 vs 6 IQR 4-6; aOR 0.4, 95% CI 0.2-0.7). Patients undergoing EVT had higher sICH (11.2% vs 4.0%; aOR 4.1, 95% CI 1.2-18.8) and lower mortality (31.6% vs 58.4%, aOR 0.4; 95% CI 0.2-0.9) compared to medically managed patients. The relative benefit of EVT was comparable between patients with ASPECTS 0 and 5 and 6-10 in the extended time window (interaction aOR 0.9; 95% CI 0.5-1.7). - Conclusion: In the extended time window, patients with ASPECTS 0-5 may have preserved relative treatment benefit of EVT compared to patients with ASPECTS 6-10. These findings are in line with recent trials showing benefit of EVT among real-world patients with large ischemic core in the extended time window. - Trial registration number: clinicaltrials.gov; Unique identifier: NCT04096248
Item Description:Gesehen am 02.12.2024
Physical Description:Online Resource
ISSN:2396-9881
DOI:10.1177/23969873241249406

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