Do Physicians Intuitively Select Slow Progressors for Thrombectomy in the Extended Time Window?
Research output: Contribution to journal › Research article › Contributed › peer-review
Contributors
Abstract
Background: In acute ischemic stroke 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 >6h from last-known-well. Methods: Retrospective analysis of the prospective, multicenter cohort study ESCAPE-LATE. Patients presenting >6h 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(mRS0-2) and poor clinical outcome(mRS5-6) 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. Hundred-thirty-five of 150 patients (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 (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
Original language | English |
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Pages (from-to) | 1-7 |
Number of pages | 7 |
Journal | The Canadian journal of neurological sciences = Le journal canadien des sciences neurologiques |
Publication status | E-pub ahead of print - 12 Mar 2025 |
Peer-reviewed | Yes |
External IDs
Scopus | 105000411381 |
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ORCID | /0000-0001-5258-0025/work/181860906 |
Keywords
ASJC Scopus subject areas
Keywords
- imaging, patient selection, slow progressors, stroke, thrombectomy