Endovascular treatment in anterior circulation stroke beyond 6.5 hours after onset or time last seen well: results from the MR CLEAN Registry
Background Randomised controlled trials with perfusion selection have shown benefit of endovascular treatment (EVT) for ischaemic stroke between 6 and 24 hours after symptom onset or time last seen well. However, outcomes after EVT in these late window patients without perfusion imaging are largely...
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
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| Series: | Stroke and Vascular Neurology |
| Online Access: | https://svn.bmj.com/content/early/2021/04/06/svn-2020-000803.full |
| _version_ | 1819142139589689344 |
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| author | Robert J van Oostenbrugge Wim H van Zwam Maarten Uyttenboogaart Yvo B W E M Roos Jeannette Hofmeijer Jasper M Martens Ivo G H Jansen Ludo F M Beenen Hester F Lingsma Albert J Yoo Diederik W J Dippel Charles B L M Majoie Olvert A Berkhemer Bart J Emmer Marianne A A van Walderveen Sjoerd F M Jenniskens Wouter J Schonewille Jan Albert Vos Julie Staals Geert J Lycklama à nijeholt Jelis Boiten Rob H Lo Ewoud J Van Dijk René J Dallinga Koos Keizer Heleen M Den Hertog Katinka R van Kranendonk Kilian M Treurniet Esmee Venema Bob Roozenbeek Robin Lemmens Robert-Jan B Goldhoorn Ido R van den Wijngaard Jonathan M Coutinho Stefan D Roosendaal Joost Bot Naziha El Ghannouti Martin Sterrenberg Wilma Pellikaan Rita Sprengers Marjan Elfrink Joke de Meris Tamara Vermeulen Annet Geerlings Gina van Vemde Tiny Simons Gert Messchendorp Hester Bongenaar Karin Bodde Sandra Kleijn Jasmijn Lodico D Jeurrissen Erna Bos Yvonne Drabbe Berber Zweedijk Daan Muijres J Huguet Marieke A Mens Manon Kappelhof Heitor Alves Manon L Tolhuisen Alida A Postma Reinoud P H Bokkers Maxim J H L Mulder Kars C J Compagne Josje Brouwer Wouter H Hinsenveld Marieke J H Wermer J de Vries Julia van Tuijl Jo P Peluso Puck Fransen Leo A M Aerden Omid Eschgi Tobien H C M L Schreuder Roel J J Heijboer Lonneke S F Yo Emiel J C Sturm Paul J A M Brouwers Marieke E S Sprengers René van den Berg Pieter-Jan van Doormaal Anton Meijer Elyas Ghariq Dick Gerrits Wouter Dinkelaar Auke P A Appelman Bas Hammer Sjoert Pegge Anouk van der Hoorn Saman Vinke Michelle Simons Marjolein Vossers Nynke Nicolaij Hanneke Droste Maureen Wollaert Sabrina Verheesen Michelle Sandiman Nicoline Aaldering Jocova Vervoort Eva Ponjee Sharon Romviel Annick J Weterings Lieve M Schupp Sabine Collette Natalie E LeCouffe Praneeta R Konduri Haryadi Prasetya Nerea Arrarte-Terreros Lucas A Ramos C Lukas Luuk Dekker F Anne V Pirson Adriaan C G M van Es Sanne J den Hartog Sebastiaan F de Bruijnl H van Dijk Bart van der Worp D Boogaarts Hieronymus Paul L M de Kort Jan S P van den Berg Boudewijn A A M van Hasselt Bas F W van der Kallen P Marc G van Proosdij; Menno Krietemeijer Roger R M Harmsma M M Anna Boers P F C Groot Eleonora L F Kirkels Eva J H F Voogd Adrien E D Groot |
| author_facet | Robert J van Oostenbrugge Wim H van Zwam Maarten Uyttenboogaart Yvo B W E M Roos Jeannette Hofmeijer Jasper M Martens Ivo G H Jansen Ludo F M Beenen Hester F Lingsma Albert J Yoo Diederik W J Dippel Charles B L M Majoie Olvert A Berkhemer Bart J Emmer Marianne A A van Walderveen Sjoerd F M Jenniskens Wouter J Schonewille Jan Albert Vos Julie Staals Geert J Lycklama à nijeholt Jelis Boiten Rob H Lo Ewoud J Van Dijk René J Dallinga Koos Keizer Heleen M Den Hertog Katinka R van Kranendonk Kilian M Treurniet Esmee Venema Bob Roozenbeek Robin Lemmens Robert-Jan B Goldhoorn Ido R van den Wijngaard Jonathan M Coutinho Stefan D Roosendaal Joost Bot Naziha El Ghannouti Martin Sterrenberg Wilma Pellikaan Rita Sprengers Marjan Elfrink Joke de Meris Tamara Vermeulen Annet Geerlings Gina van Vemde Tiny Simons Gert Messchendorp Hester Bongenaar Karin Bodde Sandra Kleijn Jasmijn Lodico D Jeurrissen Erna Bos Yvonne Drabbe Berber Zweedijk Daan Muijres J Huguet Marieke A Mens Manon Kappelhof Heitor Alves Manon L Tolhuisen Alida A Postma Reinoud P H Bokkers Maxim J H L Mulder Kars C J Compagne Josje Brouwer Wouter H Hinsenveld Marieke J H Wermer J de Vries Julia van Tuijl Jo P Peluso Puck Fransen Leo A M Aerden Omid Eschgi Tobien H C M L Schreuder Roel J J Heijboer Lonneke S F Yo Emiel J C Sturm Paul J A M Brouwers Marieke E S Sprengers René van den Berg Pieter-Jan van Doormaal Anton Meijer Elyas Ghariq Dick Gerrits Wouter Dinkelaar Auke P A Appelman Bas Hammer Sjoert Pegge Anouk van der Hoorn Saman Vinke Michelle Simons Marjolein Vossers Nynke Nicolaij Hanneke Droste Maureen Wollaert Sabrina Verheesen Michelle Sandiman Nicoline Aaldering Jocova Vervoort Eva Ponjee Sharon Romviel Annick J Weterings Lieve M Schupp Sabine Collette Natalie E LeCouffe Praneeta R Konduri Haryadi Prasetya Nerea Arrarte-Terreros Lucas A Ramos C Lukas Luuk Dekker F Anne V Pirson Adriaan C G M van Es Sanne J den Hartog Sebastiaan F de Bruijnl H van Dijk Bart van der Worp D Boogaarts Hieronymus Paul L M de Kort Jan S P van den Berg Boudewijn A A M van Hasselt Bas F W van der Kallen P Marc G van Proosdij; Menno Krietemeijer Roger R M Harmsma M M Anna Boers P F C Groot Eleonora L F Kirkels Eva J H F Voogd Adrien E D Groot |
| collection | DOAJ |
| description | Background Randomised controlled trials with perfusion selection have shown benefit of endovascular treatment (EVT) for ischaemic stroke between 6 and 24 hours after symptom onset or time last seen well. However, outcomes after EVT in these late window patients without perfusion imaging are largely unknown. We assessed their characteristics and outcomes in routine clinical practice.Methods The Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry, a prospective, multicentre study in the Netherlands, included patients with an anterior circulation occlusion who underwent EVT between 2014 and 2017. CT perfusion was no standard imaging modality. We used adjusted ordinal logistic regression analysis to compare patients treated within versus beyond 6.5 hours after propensity score matching on age, prestroke modified Rankin Scale (mRS), National Institutes of Health Stroke Scale, Alberta Stroke Programme Early CT Score (ASPECTS), collateral status, location of occlusion and treatment with intravenous thrombolysis. Outcomes included 3-month mRS score, functional independence (defined as mRS 0–2), and death.Results Of 3264 patients who underwent EVT, 106 (3.2%) were treated beyond 6.5 hours (median 8.5, IQR 6.9–10.6), of whom 93 (87.7%) had unknown time of stroke onset. CT perfusion was not performed in 87/106 (80.2%) late window patients. Late window patients were younger (mean 67 vs 70 years, p<0.04) and had slightly lower ASPECTS (median 8 vs 9, p<0.01), but better collateral status (collateral score 2–3: 68.3% vs 57.7%, p=0.03). No differences were observed in proportions of functional independence (43.3% vs 40.5%, p=0.57) or death (24.0% vs 28.9%, p=0.28). After matching, outcomes remained similar (adjusted common OR for 1 point improvement in mRS 1.04, 95% CI 0.56 to 1.93).Conclusions Without the use of CT perfusion selection criteria, EVT in the 6.5–24-hour time window was not associated with poorer outcome in selected patients with favourable clinical and CT/CT angiography characteristics. randomised controlled trials with lenient inclusion criteria are needed to identify more patients who can benefit from EVT in the late window. |
| first_indexed | 2024-12-22T12:05:36Z |
| format | Article |
| id | doaj.art-ac03b762f9b44889afdd908db471450d |
| institution | Directory Open Access Journal |
| issn | 2059-8696 |
| language | English |
| last_indexed | 2024-12-22T12:05:36Z |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Stroke and Vascular Neurology |
| spelling | doaj.art-ac03b762f9b44889afdd908db471450d2022-12-21T18:26:27ZengBMJ Publishing GroupStroke and Vascular Neurology2059-869610.1136/svn-2020-000803Endovascular treatment in anterior circulation stroke beyond 6.5 hours after onset or time last seen well: results from the MR CLEAN Registry 0Robert J van Oostenbrugge1Wim H van Zwam2Maarten UyttenboogaartYvo B W E M Roos3Jeannette HofmeijerJasper M MartensIvo G H Jansen4Ludo F M BeenenHester F Lingsma5Albert J YooDiederik W J Dippel6Charles B L M Majoie7Olvert A BerkhemerBart J Emmer8Marianne A A van WalderveenSjoerd F M JenniskensWouter J SchonewilleJan Albert VosJulie StaalsGeert J Lycklama à nijeholt9Jelis Boiten10Rob H LoEwoud J Van DijkRené J DallingaKoos KeizerHeleen M Den HertogKatinka R van KranendonkKilian M TreurnietEsmee Venema11Bob RoozenbeekRobin Lemmens12Robert-Jan B Goldhoorn13Ido R van den Wijngaard14Jonathan M CoutinhoStefan D RoosendaalJoost BotNaziha El GhannoutiMartin SterrenbergWilma PellikaanRita SprengersMarjan ElfrinkJoke de MerisTamara VermeulenAnnet GeerlingsGina van VemdeTiny SimonsGert MesschendorpHester BongenaarKarin BoddeSandra KleijnJasmijn LodicoD JeurrissenErna BosYvonne DrabbeBerber ZweedijkDaan MuijresJ HuguetMarieke A MensManon KappelhofHeitor AlvesManon L TolhuisenAlida A PostmaReinoud P H BokkersMaxim J H L Mulder15Kars C J CompagneJosje BrouwerWouter H HinsenveldMarieke J H Wermer16J de VriesJulia van TuijlJo P PelusoPuck FransenLeo A M AerdenOmid EschgiTobien H C M L SchreuderRoel J J HeijboerLonneke S F YoEmiel J C SturmPaul J A M BrouwersMarieke E S SprengersRené van den BergPieter-Jan van DoormaalAnton MeijerElyas GhariqDick GerritsWouter DinkelaarAuke P A AppelmanBas HammerSjoert PeggeAnouk van der HoornSaman VinkeMichelle SimonsMarjolein VossersNynke NicolaijHanneke DrosteMaureen WollaertSabrina VerheesenMichelle SandimanNicoline AalderingJocova VervoortEva PonjeeSharon RomvielAnnick J WeteringsLieve M SchuppSabine ColletteNatalie E LeCouffePraneeta R KonduriHaryadi PrasetyaNerea Arrarte-TerrerosLucas A RamosC LukasLuuk Dekker17F Anne V Pirson18Adriaan C G M van Es19Sanne J den HartogSebastiaan F de BruijnlH van DijkBart van der WorpD Boogaarts HieronymusPaul L M de KortJan S P van den BergBoudewijn A A M van HasseltBas F W van der KallenP MarcG van Proosdij;Menno KrietemeijerRoger R M HarmsmaM M Anna BoersP F C GrootEleonora L F KirkelsEva J H F VoogdAdrien E D GrootDepartment of Clinical Surgery, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UKNeurology, Maastricht University Medical Centre+, Maastricht, The NetherlandsRadiology, Maastricht University Medical Centre+, Maastricht, The NetherlandsNeurology, Amsterdam University Medical Centre, Location AMC, Amsterdam, The NetherlandsRadiology and Nuclear Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, The NetherlandsPublic Health, Erasmus MC, Rotterdam, The NetherlandsNeurology, Erasmus MC, Rotterdam, The NetherlandsRadiology and Nuclear Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, The NetherlandsRadiology and Nuclear Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, The NetherlandsRadiology, Haaglanden Medical Centre, Den Haag, The NetherlandsNeurology, Haaglanden Medical Centre, Den Haag, The NetherlandsNeurology, Erasmus MC, Rotterdam, The NetherlandsNeurology, University Hospitals Leuven, Leuven, BelgiumNeurology, Maastricht University Medical Centre+, Maastricht, The NetherlandsNeurology, Leiden University Medical Centre, Leiden, The NetherlandsNeurology, Erasmus MC, Rotterdam, The NetherlandsNeurology, Leiden University Medical Centre, Leiden, The NetherlandsNeurology, Leiden University Medical Centre, Leiden, The NetherlandsNeurology, Maastricht University Medical Centre+, Maastricht, The NetherlandsRadiology, Haaglanden Medical Centre, Den Haag, The NetherlandsBackground Randomised controlled trials with perfusion selection have shown benefit of endovascular treatment (EVT) for ischaemic stroke between 6 and 24 hours after symptom onset or time last seen well. However, outcomes after EVT in these late window patients without perfusion imaging are largely unknown. We assessed their characteristics and outcomes in routine clinical practice.Methods The Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry, a prospective, multicentre study in the Netherlands, included patients with an anterior circulation occlusion who underwent EVT between 2014 and 2017. CT perfusion was no standard imaging modality. We used adjusted ordinal logistic regression analysis to compare patients treated within versus beyond 6.5 hours after propensity score matching on age, prestroke modified Rankin Scale (mRS), National Institutes of Health Stroke Scale, Alberta Stroke Programme Early CT Score (ASPECTS), collateral status, location of occlusion and treatment with intravenous thrombolysis. Outcomes included 3-month mRS score, functional independence (defined as mRS 0–2), and death.Results Of 3264 patients who underwent EVT, 106 (3.2%) were treated beyond 6.5 hours (median 8.5, IQR 6.9–10.6), of whom 93 (87.7%) had unknown time of stroke onset. CT perfusion was not performed in 87/106 (80.2%) late window patients. Late window patients were younger (mean 67 vs 70 years, p<0.04) and had slightly lower ASPECTS (median 8 vs 9, p<0.01), but better collateral status (collateral score 2–3: 68.3% vs 57.7%, p=0.03). No differences were observed in proportions of functional independence (43.3% vs 40.5%, p=0.57) or death (24.0% vs 28.9%, p=0.28). After matching, outcomes remained similar (adjusted common OR for 1 point improvement in mRS 1.04, 95% CI 0.56 to 1.93).Conclusions Without the use of CT perfusion selection criteria, EVT in the 6.5–24-hour time window was not associated with poorer outcome in selected patients with favourable clinical and CT/CT angiography characteristics. randomised controlled trials with lenient inclusion criteria are needed to identify more patients who can benefit from EVT in the late window.https://svn.bmj.com/content/early/2021/04/06/svn-2020-000803.full |
| spellingShingle | Robert J van Oostenbrugge Wim H van Zwam Maarten Uyttenboogaart Yvo B W E M Roos Jeannette Hofmeijer Jasper M Martens Ivo G H Jansen Ludo F M Beenen Hester F Lingsma Albert J Yoo Diederik W J Dippel Charles B L M Majoie Olvert A Berkhemer Bart J Emmer Marianne A A van Walderveen Sjoerd F M Jenniskens Wouter J Schonewille Jan Albert Vos Julie Staals Geert J Lycklama à nijeholt Jelis Boiten Rob H Lo Ewoud J Van Dijk René J Dallinga Koos Keizer Heleen M Den Hertog Katinka R van Kranendonk Kilian M Treurniet Esmee Venema Bob Roozenbeek Robin Lemmens Robert-Jan B Goldhoorn Ido R van den Wijngaard Jonathan M Coutinho Stefan D Roosendaal Joost Bot Naziha El Ghannouti Martin Sterrenberg Wilma Pellikaan Rita Sprengers Marjan Elfrink Joke de Meris Tamara Vermeulen Annet Geerlings Gina van Vemde Tiny Simons Gert Messchendorp Hester Bongenaar Karin Bodde Sandra Kleijn Jasmijn Lodico D Jeurrissen Erna Bos Yvonne Drabbe Berber Zweedijk Daan Muijres J Huguet Marieke A Mens Manon Kappelhof Heitor Alves Manon L Tolhuisen Alida A Postma Reinoud P H Bokkers Maxim J H L Mulder Kars C J Compagne Josje Brouwer Wouter H Hinsenveld Marieke J H Wermer J de Vries Julia van Tuijl Jo P Peluso Puck Fransen Leo A M Aerden Omid Eschgi Tobien H C M L Schreuder Roel J J Heijboer Lonneke S F Yo Emiel J C Sturm Paul J A M Brouwers Marieke E S Sprengers René van den Berg Pieter-Jan van Doormaal Anton Meijer Elyas Ghariq Dick Gerrits Wouter Dinkelaar Auke P A Appelman Bas Hammer Sjoert Pegge Anouk van der Hoorn Saman Vinke Michelle Simons Marjolein Vossers Nynke Nicolaij Hanneke Droste Maureen Wollaert Sabrina Verheesen Michelle Sandiman Nicoline Aaldering Jocova Vervoort Eva Ponjee Sharon Romviel Annick J Weterings Lieve M Schupp Sabine Collette Natalie E LeCouffe Praneeta R Konduri Haryadi Prasetya Nerea Arrarte-Terreros Lucas A Ramos C Lukas Luuk Dekker F Anne V Pirson Adriaan C G M van Es Sanne J den Hartog Sebastiaan F de Bruijnl H van Dijk Bart van der Worp D Boogaarts Hieronymus Paul L M de Kort Jan S P van den Berg Boudewijn A A M van Hasselt Bas F W van der Kallen P Marc G van Proosdij; Menno Krietemeijer Roger R M Harmsma M M Anna Boers P F C Groot Eleonora L F Kirkels Eva J H F Voogd Adrien E D Groot Endovascular treatment in anterior circulation stroke beyond 6.5 hours after onset or time last seen well: results from the MR CLEAN Registry Stroke and Vascular Neurology |
| title | Endovascular treatment in anterior circulation stroke beyond 6.5 hours after onset or time last seen well: results from the MR CLEAN Registry |
| title_full | Endovascular treatment in anterior circulation stroke beyond 6.5 hours after onset or time last seen well: results from the MR CLEAN Registry |
| title_fullStr | Endovascular treatment in anterior circulation stroke beyond 6.5 hours after onset or time last seen well: results from the MR CLEAN Registry |
| title_full_unstemmed | Endovascular treatment in anterior circulation stroke beyond 6.5 hours after onset or time last seen well: results from the MR CLEAN Registry |
| title_short | Endovascular treatment in anterior circulation stroke beyond 6.5 hours after onset or time last seen well: results from the MR CLEAN Registry |
| title_sort | endovascular treatment in anterior circulation stroke beyond 6 5 hours after onset or time last seen well results from the mr clean registry |
| url | https://svn.bmj.com/content/early/2021/04/06/svn-2020-000803.full |
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