Do Physicians Intuitively Select Slow Progressors for Thrombectomy in the Extended Time Window?

Publikation: Beitrag in FachzeitschriftForschungsartikelBeigetragenBegutachtung

Beitragende

  • Salome L Bosshart - , Universitätsspital Zürich (Autor:in)
  • Alexander Stebner - , Kantonsspital Münsterlingen (Autor:in)
  • Charlotte Zerna - , Städtisches Klinikum Dresden (Autor:in)
  • Emma Harrison - , Princess Alexandra Hospital Brisbane (Autor:in)
  • Timothy Kleinig - , Royal Adelaide Hospital (Autor:in)
  • Volker Puetz - , Klinik und Poliklinik für Neurologie (Autor:in)
  • Daniel P O Kaiser - , Institut und Poliklinik für Diagnostische und Interventionelle Neuroradiologie (Autor:in)
  • Brett Graham - , Saskatchewan Health Authority (Autor:in)
  • Amy Y X Yu - , Sunnybrook Health Science Centre (Autor:in)
  • Brian van Adel - , Hamilton Health Sciences, McMaster University (Autor:in)
  • Jai Shankar - , University of Manitoba (Autor:in)
  • Ryan McTaggart - , Brown University (Autor:in)
  • Vitor Pereira - , Unity Health Toronto (Autor:in)
  • Don F Frei - , Colorado Neurological Institute (Autor:in)
  • Mayank Goyal - , University of Calgary (Autor:in)
  • Michael D Hill - , University of Calgary (Autor:in)
  • Johanna M Ospel - , University of Calgary (Autor:in)

Abstract

Background: In acute ischemic stroke, a longer time from onset to endovascular treatment (EVT) is associated with worse clinical outcome. We investigated the association of clinical outcome with time from last known well to arrival at the EVT hospital and time from hospital arrival to arterial access for anterior circulation large vessel occlusion patients treated > 6 hours from last known well. Methods: Retrospective analysis of the prospective, multicenter cohort study ESCAPE-LATE. Patients presenting > 6 hours after last known well with anterior circulation large vessel occlusion undergoing EVT were included. The primary outcome was the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes were good (mRS 0-2) and poor clinical outcomes (mRS 5-6) at 90 days, as well as the National Institutes of Health Stroke Scale at 24 hours. Associations of time intervals with outcomes were assessed with univariable and multivariable logistic regression. Results: Two hundred patients were included in the analysis, of whom 85 (43%) were female. 90-day mRS was available for 141 patients. Of the 150 patients, 135 (90%) had moderate-to-good collaterals, and the median Alberta Stroke Program Early CT Score (ASPECTS) was 8 (IQR = 7-10). No association between ordinal mRS and time from last known well to arrival at the EVT hospital (odds ratio [OR] = 1.01, 95% CI = 1.00-1.02) or time from hospital arrival to arterial access (OR = -0.01, 95% CI = -0.02-0.00) was seen in adjusted regression models. Conclusion: No relationship was observed between pre-hospital or in-hospital workflow times and clinical outcomes. Baseline ASPECTS and collateral status were favorable in the majority of patients, suggesting that physicians may have chosen to predominantly treat slow progressors in the late time window, in whom prolonged workflow times have less impact on outcomes.

Details

OriginalspracheEnglisch
Seiten (von - bis)982-988
Seitenumfang7
FachzeitschriftThe Canadian journal of neurological sciences = Le journal canadien des sciences neurologiques
Jahrgang52
Ausgabenummer6
Frühes Online-Datum12 März 2025
PublikationsstatusVeröffentlicht - 1 Nov. 2025
Peer-Review-StatusJa

Externe IDs

Scopus 105000411381
ORCID /0000-0001-5258-0025/work/181860906

Schlagworte

ASJC Scopus Sachgebiete

Schlagwörter

  • imaging, patient selection, slow progressors, stroke, thrombectomy