41. ENDOVASCULAR TREATMENT FOR THE PATIENTS WITH ACUTE ISCHEMIC STROKE IN THE BEYOND 6-HOUR: TIME WINDOW VERSUS TISSUE WINDOW
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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.
Article Details
Keywords
Stroke, endovascular intervention, parenchymal window
References
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