Articles Vol. 65 No. 5 04/09/2024

41. ENDOVASCULAR TREATMENT FOR THE PATIENTS WITH ACUTE ISCHEMIC STROKE IN THE BEYOND 6-HOUR: TIME WINDOW VERSUS TISSUE WINDOW

Tran Van Song1,2, Duong Huy Luong3,4, Nguyen Quoc Trung1,2, Phan Bang5,6, Nguyen Minh Hung7,8, Tran Thi Minh Hang1,2,9,10, Nguyen Huy Thang2,10
1 115 People's Hospital
2 Bệnh viện Nhân dân 115
3 Department of Medical Services Administration, MOH
4 Cục Quản lý khám chữa bệnh, Bộ Y tế
5 Buon Ma Thuot University of Medicine and Pharmacy Hospital
6 Bệnh viện Đại học Y Dược Buôn Ma Thuột
7 Trung Vuong Hospital
8 Bệnh viện Trưng Vương
9 Pham Ngoc Thach University of Medicine
10 Trường Đại học Y Khoa Phạm Ngọc Thạch
Corresponding author: quoctrungyds09@gmail.com
DOI: 10.52163/yhc.v65i5.1443
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Keywords
Stroke endovascular intervention parenchymal window
Abstract

Objective: To compare outcomes in patients with ischemic stroke aged 18 years and older who received endovascular intervention within 6-16 hours versus within 16 hours based on perfusion imaging and core infarction discordance.

Subject and methods: Retrospective analysis was conducted on data collected (prospectively) in patients treated with endovascular intervention in the anterior circulation, after 6 hours from onset. A modified Rankin score (mRS) of 0-2 is considered good functional outcome at 90 days. Patients were selected based on clinical and imaging discordance based on the criteria of the DEFUSE 3 study in both groups except for time criteria.

Results: Among 165 patients with large cerebral embolic stroke in the study, 79 patients (47.9%) received endovascular intervention within a window after 16 hours from the time of onset; 86 patients (52.1%) received intervention within a 6-16 hour window. Patients in the 6-16 hour window group had a shorter time from onset to femoral artery puncture than those in the 16 hour window group (median 12.2 hours vs 20.5 hours, p < 0.001). There was no statistically significant difference between the two groups in terms of NIHSS score (median 14.5 vs 15.0, p = 0.46). Perfusion imaging characteristics (infarct core: median 9 ml vs 9 ml, p = 0.67; penumbra volume: median 112 ml vs 103 ml, p = 0.61; discordance ratio: median 7.1 vs 7.24, p = 0.88) and time from perfusion imaging to femoral artery puncture (median position 73 minutes vs 81 minutes, p = 0.2). There was no significant difference between the two groups in functional independence (48.8% vs 44.3%, p = 0.56), 90-day mortality (9.3% vs 13.9%, p = 0.35), successful cerebral revascularization rate (91.9% vs 82.3%, p = 0.065), symptomatic cerebral hemorrhage (2.3% vs 3, 8%, p = 0.67).

Conclusion: In this study, regardless of the time window, patients selected for endovascular treatment based on perfusion imaging and core infarction discordance had similar outcomes.

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