Clinical and Safety Outcomes of Endovascular Therapy 6 to 24 Hours After Large Vessel Occlusion Ischemic Stroke With Tandem Lesions
Background and Purpose Effect of endovascular therapy (EVT) in acute large vessel occlusion (LVO) patients with tandem lesions (TLs) within 6–24 hours after last known well (LKW) remains unclear. We evaluated the clinical and safety outcomes among TL-LVO patients treated within 6–24 hours. Methods T...
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| Format: | Article |
| Language: | English |
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Korean Stroke Society
2023-09-01
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| Series: | Journal of Stroke |
| Subjects: | |
| Online Access: | http://www.j-stroke.org/upload/pdf/jos-2023-00759.pdf |
| _version_ | 1797653516437684224 |
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| author | Milagros Galecio-Castillo Mudassir Farooqui Ameer E. Hassan Mouhammad A. Jumaa Afshin A. Divani Marc Ribo Michael Abraham Nils H. Petersen Johanna T. Fifi Waldo R. Guerrero Amer M. Malik James E. Siegler Thanh N. Nguyen Sunil Sheth Albert J. Yoo Guillermo Linares Nazli Janjua Darko Quispe-Orozco Wondwossen Tekle Syed F. Zaidi Sara Y. Sabbagh Marta Olivé-Gadea Tiffany Barkley Reade De Leacy Kenyon W. Sprankle Mohamad Abdalkader Sergio Salazar-Marioni Jazba Soomro Weston Gordon Charoskhon Turabova Juan Vivanco-Suarez Aaron Rodriguez-Calienes Maxim Mokin Dileep R. Yavagal Tudor Jovin Santiago Ortega-Gutierrez |
| author_facet | Milagros Galecio-Castillo Mudassir Farooqui Ameer E. Hassan Mouhammad A. Jumaa Afshin A. Divani Marc Ribo Michael Abraham Nils H. Petersen Johanna T. Fifi Waldo R. Guerrero Amer M. Malik James E. Siegler Thanh N. Nguyen Sunil Sheth Albert J. Yoo Guillermo Linares Nazli Janjua Darko Quispe-Orozco Wondwossen Tekle Syed F. Zaidi Sara Y. Sabbagh Marta Olivé-Gadea Tiffany Barkley Reade De Leacy Kenyon W. Sprankle Mohamad Abdalkader Sergio Salazar-Marioni Jazba Soomro Weston Gordon Charoskhon Turabova Juan Vivanco-Suarez Aaron Rodriguez-Calienes Maxim Mokin Dileep R. Yavagal Tudor Jovin Santiago Ortega-Gutierrez |
| author_sort | Milagros Galecio-Castillo |
| collection | DOAJ |
| description | Background and Purpose Effect of endovascular therapy (EVT) in acute large vessel occlusion (LVO) patients with tandem lesions (TLs) within 6–24 hours after last known well (LKW) remains unclear. We evaluated the clinical and safety outcomes among TL-LVO patients treated within 6–24 hours. Methods This multicenter cohort was divided into two groups, based on LKW to puncture time: early window (<6 hours), and late window (6–24 hours). Primary clinical and safety outcomes were 90-day functional independence measured by the modified Rankin Scale (mRS: 0–2) and symptomatic intracranial hemorrhage (sICH). Secondary outcomes were successful reperfusion (modified Thrombolysis in Cerebral Infarction score ≥2b), first-pass effect, early neurological improvement, ordinal mRS, and in-hospital and 90-day mortality. Results Of 579 patients (median age 68, 32.1% females), 268 (46.3%) were treated in the late window and 311 (53.7%) in the early window. Late window group had lower median National Institutes of Health Stroke Scale score at admission, Alberta Stroke Program Early Computed Tomography Score, rates of intravenous thrombolysis, and higher rates for perfusion imaging. After adjusting for confounders, the odds of 90-day mRS 0–2 (47.7% vs. 45.0%, adjusted odds ratio [aOR] 0.71, 95% confidence interval [CI] 0.49–1.02), favorable shift in mRS (aOR 0.88, 95% CI 0.44–1.76), and sICH (3.7% vs. 5.2%, aOR 0.56, 95% CI 0.20–1.56) were similar in both groups. There was no difference in secondary outcomes. Increased time from LKW to puncture did not predicted the probability of 90-day mRS 0–2 (aOR 0.99, 95% CI 0.96–1.01, for each hour delay) among patients presenting <24 hours. Conclusion EVT for acute TL-LVO treated within 6–24 hours after LKW was associated with similar rates of clinical and safety outcomes, compared to patients treated within 6 hours. |
| first_indexed | 2024-03-11T16:45:42Z |
| format | Article |
| id | doaj.art-d1c2c3f396414bf48452a3bc383704a7 |
| institution | Directory Open Access Journal |
| issn | 2287-6391 2287-6405 |
| language | English |
| last_indexed | 2024-03-11T16:45:42Z |
| publishDate | 2023-09-01 |
| publisher | Korean Stroke Society |
| record_format | Article |
| series | Journal of Stroke |
| spelling | doaj.art-d1c2c3f396414bf48452a3bc383704a72023-10-23T00:18:04ZengKorean Stroke SocietyJournal of Stroke2287-63912287-64052023-09-0125337838710.5853/jos.2023.00759495Clinical and Safety Outcomes of Endovascular Therapy 6 to 24 Hours After Large Vessel Occlusion Ischemic Stroke With Tandem LesionsMilagros Galecio-Castillo0Mudassir Farooqui1Ameer E. Hassan2Mouhammad A. Jumaa3Afshin A. Divani4Marc Ribo5Michael Abraham6Nils H. Petersen7Johanna T. Fifi8Waldo R. Guerrero9Amer M. Malik10James E. Siegler11Thanh N. Nguyen12Sunil Sheth13Albert J. Yoo14Guillermo Linares15Nazli Janjua16Darko Quispe-Orozco17Wondwossen Tekle18Syed F. Zaidi19Sara Y. Sabbagh20Marta Olivé-Gadea21Tiffany Barkley22Reade De Leacy23Kenyon W. Sprankle24Mohamad Abdalkader25Sergio Salazar-Marioni26Jazba Soomro27Weston Gordon28Charoskhon Turabova29Juan Vivanco-Suarez30Aaron Rodriguez-Calienes31Maxim Mokin32Dileep R. Yavagal33Tudor Jovin34Santiago Ortega-Gutierrez35 Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA Department of Neurology, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen, TX, USA Department of Neurology, ProMedica Toledo Hospital, Toledo, OH, USA Department of Neurology, University of New Mexico Health Science Center, Albuquerque, NM, USA Department of Neurology, Hospital Vall d’Hebron, Barcelona, Spain Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA Department of Neurology, Yale University School of Medicine, New Haven, CT, USA Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA Department of Neurology and Brain Repair, University of South Florida, Tampa, FL, USA Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA Department of Neurology, Boston Medical Center, Boston, MA, USA Department of Neurology, UT Health McGovern Medical School, Houston, TX, USA Texas Stroke Institute, Dallas-Fort Worth, TX, USA Department of Neurology, Saint Louis University, St. Louis, MO, USA Asia Pacific Comprehensive Stroke Institute, Pomona Valley Hospital Medical Center, Pomona, CA, USA Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA Department of Neurology, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen, TX, USA Department of Neurology, ProMedica Toledo Hospital, Toledo, OH, USA Department of Neurology, University of New Mexico Health Science Center, Albuquerque, NM, USA Department of Neurology, Hospital Vall d’Hebron, Barcelona, Spain Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA Cooper Medical School of Rowan University, Camden, NJ, USA Department of Radiology, Boston Medical Center, Boston, MA, USA Department of Neurology, UT Health McGovern Medical School, Houston, TX, USA Texas Stroke Institute, Dallas-Fort Worth, TX, USA Department of Neurology, Saint Louis University, St. Louis, MO, USA Asia Pacific Comprehensive Stroke Institute, Pomona Valley Hospital Medical Center, Pomona, CA, USA Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA Department of Neurology and Brain Repair, University of South Florida, Tampa, FL, USA Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USABackground and Purpose Effect of endovascular therapy (EVT) in acute large vessel occlusion (LVO) patients with tandem lesions (TLs) within 6–24 hours after last known well (LKW) remains unclear. We evaluated the clinical and safety outcomes among TL-LVO patients treated within 6–24 hours. Methods This multicenter cohort was divided into two groups, based on LKW to puncture time: early window (<6 hours), and late window (6–24 hours). Primary clinical and safety outcomes were 90-day functional independence measured by the modified Rankin Scale (mRS: 0–2) and symptomatic intracranial hemorrhage (sICH). Secondary outcomes were successful reperfusion (modified Thrombolysis in Cerebral Infarction score ≥2b), first-pass effect, early neurological improvement, ordinal mRS, and in-hospital and 90-day mortality. Results Of 579 patients (median age 68, 32.1% females), 268 (46.3%) were treated in the late window and 311 (53.7%) in the early window. Late window group had lower median National Institutes of Health Stroke Scale score at admission, Alberta Stroke Program Early Computed Tomography Score, rates of intravenous thrombolysis, and higher rates for perfusion imaging. After adjusting for confounders, the odds of 90-day mRS 0–2 (47.7% vs. 45.0%, adjusted odds ratio [aOR] 0.71, 95% confidence interval [CI] 0.49–1.02), favorable shift in mRS (aOR 0.88, 95% CI 0.44–1.76), and sICH (3.7% vs. 5.2%, aOR 0.56, 95% CI 0.20–1.56) were similar in both groups. There was no difference in secondary outcomes. Increased time from LKW to puncture did not predicted the probability of 90-day mRS 0–2 (aOR 0.99, 95% CI 0.96–1.01, for each hour delay) among patients presenting <24 hours. Conclusion EVT for acute TL-LVO treated within 6–24 hours after LKW was associated with similar rates of clinical and safety outcomes, compared to patients treated within 6 hours.http://www.j-stroke.org/upload/pdf/jos-2023-00759.pdfischemic strokecarotid artery diseasestandem lesionsthrombectomyearly windowlate window |
| spellingShingle | Milagros Galecio-Castillo Mudassir Farooqui Ameer E. Hassan Mouhammad A. Jumaa Afshin A. Divani Marc Ribo Michael Abraham Nils H. Petersen Johanna T. Fifi Waldo R. Guerrero Amer M. Malik James E. Siegler Thanh N. Nguyen Sunil Sheth Albert J. Yoo Guillermo Linares Nazli Janjua Darko Quispe-Orozco Wondwossen Tekle Syed F. Zaidi Sara Y. Sabbagh Marta Olivé-Gadea Tiffany Barkley Reade De Leacy Kenyon W. Sprankle Mohamad Abdalkader Sergio Salazar-Marioni Jazba Soomro Weston Gordon Charoskhon Turabova Juan Vivanco-Suarez Aaron Rodriguez-Calienes Maxim Mokin Dileep R. Yavagal Tudor Jovin Santiago Ortega-Gutierrez Clinical and Safety Outcomes of Endovascular Therapy 6 to 24 Hours After Large Vessel Occlusion Ischemic Stroke With Tandem Lesions Journal of Stroke ischemic stroke carotid artery diseases tandem lesions thrombectomy early window late window |
| title | Clinical and Safety Outcomes of Endovascular Therapy 6 to 24 Hours After Large Vessel Occlusion Ischemic Stroke With Tandem Lesions |
| title_full | Clinical and Safety Outcomes of Endovascular Therapy 6 to 24 Hours After Large Vessel Occlusion Ischemic Stroke With Tandem Lesions |
| title_fullStr | Clinical and Safety Outcomes of Endovascular Therapy 6 to 24 Hours After Large Vessel Occlusion Ischemic Stroke With Tandem Lesions |
| title_full_unstemmed | Clinical and Safety Outcomes of Endovascular Therapy 6 to 24 Hours After Large Vessel Occlusion Ischemic Stroke With Tandem Lesions |
| title_short | Clinical and Safety Outcomes of Endovascular Therapy 6 to 24 Hours After Large Vessel Occlusion Ischemic Stroke With Tandem Lesions |
| title_sort | clinical and safety outcomes of endovascular therapy 6 to 24 hours after large vessel occlusion ischemic stroke with tandem lesions |
| topic | ischemic stroke carotid artery diseases tandem lesions thrombectomy early window late window |
| url | http://www.j-stroke.org/upload/pdf/jos-2023-00759.pdf |
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