Benefits of Endovascular Treatment in Late Window for Acute Ischemic Stroke Selected without CT Perfusion: A Real-World Study

Yuan Yang; Ting Cui; Zuoxiao Li; Jinglun Li; Ting Duan; Zhengzhou Yuan; Changyi Wang; Jincheng Wan; Cao Li; Shujiang Zhang; Ling Li; Fayun Hu; Bo Wu

doi:10.2147/CIA.S362119

Benefits of Endovascular Treatment in Late Window for Acute Ischemic Stroke Selected without CT Perfusion: A Real-World Study

Clin Interv Aging. 2022 Apr 22:17:577-587. doi: 10.2147/CIA.S362119. eCollection 2022.

Authors

Yuan Yang^{1

2}, Ting Cui¹, Zuoxiao Li², Jinglun Li², Ting Duan³, Zhengzhou Yuan², Changyi Wang¹, Jincheng Wan¹, Cao Li⁴, Shujiang Zhang², Ling Li², Fayun Hu¹, Bo Wu¹

Affiliations

¹ Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
² Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China.
³ Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
⁴ Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China.

Abstract

Objective: This study examined the functional outcomes and safety of endovascular treatment (EVT) in acute ischemic stroke (AIS) patients owing to large vessel occlusion of the anterior circulation, presented during a late-time window (6-24 hours after last seen well (LSW)) in a real-world practice.

Methods: This was a retrospective analysis from a bi-center prospective cohort. According to the stroke treatment, patients with continuous Alberta Stroke Plan Early Aspect score (ASPECTS) ≥6 on non-contrast CT (NCCT) and moderate to good collateral state on CT angiography (CTA) were divided into EVT group and standard medical treatment (SMT) group. The primary outcome was the rate of functional independence (90-day mRS ≤2). Safety outcomes were the occurrence of symptomatic intracranial hemorrhage (sICH) and the 90-day mortality.

Results: Among the 288 enrolled patients (53.5% male, median age 64 years), there were 167 patients in the EVT group and 121 in the SMT group. After multivariable adjustments for potential confounders, EVT was associated with functional independence (adjusted OR: 3.052; 95% confidence interval (CI): 1.553-5.997; p = 0.001). In the PSM cohort, 44.2% (42/95) of patients in the EVT group versus 18.9% (18/95) in the SMT group achieved functional independence (OR: 3.39, 95% CI: 1.763-6.517), and there was a significant difference favoring EVT over the SMT in the overall distribution of mRS (OR: 2.170, 95% CI: 1.302-3.618) at 90 days. The rate of sICH did not differ between the EVT and SMT groups (10.5% vs 8.4%, p = 0.804) nor did 90-day mortality (18.9% vs 22.1%, p = 0.719). No interaction was found in p-values with statistical significance in subgroup analysis.

Conclusion: This real-world experience suggests that EVT for late-presenting stroke patients, based on small core on NCCT and moderate to good collaterals on CTA, is associated with better outcomes than SMT alone, with no increase in sICH and 90-day mortality rates.

Keywords: endovascular treatment; late time window; propensity score matching; real-world study.

MeSH terms

Female
Humans
Intracranial Hemorrhages
Ischemic Stroke* / diagnostic imaging
Ischemic Stroke* / surgery
Male
Perfusion
Prospective Studies
Retrospective Studies
Stroke* / diagnostic imaging
Stroke* / surgery
Tomography, X-Ray Computed

Grants and funding

This work was supported by the National Natural Science Foundation of China (82071320, 81870937), and the 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (ZYGD 18009).