Title |
Endovascular Thrombectomy >24-hr From Stroke Symptom Onset
|
---|---|
Published in |
Frontiers in Neurology, July 2018
|
DOI | 10.3389/fneur.2018.00501 |
Pubmed ID | |
Authors |
Nathan W. Manning, Jason Wenderoth, Khalid Alsahli, Dennis Cordato, Cecilia Cappelen-Smith, Alan McDougall, Alessandro S. Zagami, Andrew Cheung |
Abstract |
Background: Trials have demonstrated efficacy for endovascular thrombectomy (EVT) for anterior circulation acute ischaemic stroke (AIS) up to 24-h from symptom onset. The magnitude of effect suggests benefit may exist beyond 24-h. Objectives: To perform a retrospective review of all patients undergoing EVT for anterior circulation LVO stroke beyond 24-h from symptom onset and assess safety and efficacy. Methods:A prospectively maintained database of EVT patients treated at two comprehensive stroke centers between January 2016 and December 2017 was retrospectively screened. Patients undergoing EVT for anterior circulation AIS >24-h from symptom onset were selected. Results: A total of 429 AIS patient underwent EVT in the study period. Five patients treated >24-h from symptom onset were identified. The median age was 72 (range 42-84); median ASPECTS 8 (range 6-8); median baseline-NIHSS 9 (range 4-17); and median time from symptom onset to groin puncture 44 h and 55 min (range 25:07-90:10). One patient underwent CT perfusion imaging. The remaining four patients were selected based on non-contrast CT brain and CT-angiography. Two patients had tandem cervical carotid lesions and underwent acute stenting. Modified thrombolysis in cerebral ischaemia (mTICI) 3 reperfusion was achieved in four patients. No hemorrhagic transformation occurred. All patients were alive at 90-day follow-up. Four patients achieved functional independence at 90-days (mRS 0-2). Conclusion: Endovascular thrombectomy for AIS patients beyond 24-h from symptom onset appears to be safe and effective in this limited study. There is a need for further evidence-based trials of benefit vs. risk in very prolonged time windows. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United States | 2 | 22% |
New Zealand | 1 | 11% |
Switzerland | 1 | 11% |
Brazil | 1 | 11% |
France | 1 | 11% |
Australia | 1 | 11% |
Unknown | 2 | 22% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 6 | 67% |
Practitioners (doctors, other healthcare professionals) | 2 | 22% |
Scientists | 1 | 11% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 40 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Other | 9 | 23% |
Student > Bachelor | 6 | 15% |
Researcher | 4 | 10% |
Student > Master | 4 | 10% |
Student > Ph. D. Student | 3 | 8% |
Other | 2 | 5% |
Unknown | 12 | 30% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 10 | 25% |
Neuroscience | 4 | 10% |
Business, Management and Accounting | 1 | 3% |
Nursing and Health Professions | 1 | 3% |
Computer Science | 1 | 3% |
Other | 3 | 8% |
Unknown | 20 | 50% |