Journal article
Endovascular Treatment in the DEFUSE 3 Study
Stroke (1970), Vol.49(8), pp.2000-2003
08/2018
DOI: 10.1161/STROKEAHA.118.022147
PMCID: PMC6202142
PMID: 29986935
Abstract
Background and Purpose- Endovascular therapy in an extended time window has been shown to be beneficial in selected patients. This study correlated angiographic outcomes of patients randomized to endovascular therapy with clinical and imaging outcomes in the DEFUSE 3 study (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3). Methods- Angiograms were assessed for the primary arterial occlusive lesion and the modified Thrombolysis in Cerebral Infarction (TICI) score at baseline and the final modified TICI score. Clinical outcomes were assessed using an ordinal analysis of 90-day modified Rankin Scale and a dichotomous analysis for functional independence (modified Rankin Scale score of 0-2). TICI scores were correlated with outcome, types of device used for thrombectomy, and 24-hour follow-up imaging. Results- TICI 2B-3 reperfusion was achieved in 70 of 92 patients (76%). TICI 2B-3 reperfusion showed a more favorable distribution of Rankin scores compared with TICI 0-2A; odds ratio, 2.77; 95% confidence interval, 1.17-6.56; P=0.019. Good functional outcome (90-day modified Rankin Scale score of 0-2) increased with better TICI scores ( P=0.0028). There was less disability comparing TICI 3 patients to TICI 2B patients ( P=0.037). Successful reperfusion (TICI 2B-3) was independent of the device used, the site of occlusion (internal carotid artery or M1) or adjunctive use of carotid angioplasty and stenting. Significantly less infarct growth at 24 hours was seen in TICI 3 patients compared with TICI 0-2A ( P=0.0015) and TICI 2B ( P=0.0002) patients. Conclusions- Thrombectomy in an extended time window demonstrates similar rates of TICI 2B-3 reperfusion to earlier time window studies. Successful reperfusion was independent of the device used, the site of occlusion or adjunctive use of carotid angioplasty and stenting. TICI 3 reperfusion was more likely to result in low rates of infarct growth at 24 hours and good functional outcome at 90 days. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT02586415.
Details
- Title: Subtitle
- Endovascular Treatment in the DEFUSE 3 Study
- Creators
- Michael P Marks - From the Departments of Radiology and Neurology, Stanford Stroke Center, CA (M.P.M., J.J.H., M.G.L., S.K., S.C., S.H., M.M., G.W.A.)Jeremy J Heit - From the Departments of Radiology and Neurology, Stanford Stroke Center, CA (M.P.M., J.J.H., M.G.L., S.K., S.C., S.H., M.M., G.W.A.)Maarten G Lansberg - From the Departments of Radiology and Neurology, Stanford Stroke Center, CA (M.P.M., J.J.H., M.G.L., S.K., S.C., S.H., M.M., G.W.A.)Stephanie Kemp - From the Departments of Radiology and Neurology, Stanford Stroke Center, CA (M.P.M., J.J.H., M.G.L., S.K., S.C., S.H., M.M., G.W.A.)Soren Christensen - From the Departments of Radiology and Neurology, Stanford Stroke Center, CA (M.P.M., J.J.H., M.G.L., S.K., S.C., S.H., M.M., G.W.A.)Colin P Derdeyn - Department of Radiology, University of Iowa (C.P.D.)Peter A Rasmussen - Department of Neurological Surgery and the Cerebrovascular Center, Cleveland Clinic, OH (P.A.R.)Osama O Zaidat - Department of Neurosurgery, Mercy Health, Toledo, OH (O.O.Z.)Joseph P Broderick - Department of Neurology, University of Cincinnati, OH (J.P.B.)Sharon D Yeatts - Department of Public Health Sciences, Medical University of South Carolina, Charleston (S.D.Y.)Scott Hamilton - From the Departments of Radiology and Neurology, Stanford Stroke Center, CA (M.P.M., J.J.H., M.G.L., S.K., S.C., S.H., M.M., G.W.A.)Michael Mlynash - From the Departments of Radiology and Neurology, Stanford Stroke Center, CA (M.P.M., J.J.H., M.G.L., S.K., S.C., S.H., M.M., G.W.A.)Gregory W Albers - From the Departments of Radiology and Neurology, Stanford Stroke Center, CA (M.P.M., J.J.H., M.G.L., S.K., S.C., S.H., M.M., G.W.A.)
- Resource Type
- Journal article
- Publication Details
- Stroke (1970), Vol.49(8), pp.2000-2003
- Publisher
- United States
- DOI
- 10.1161/STROKEAHA.118.022147
- PMID
- 29986935
- PMCID
- PMC6202142
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Grant note
- U10 NS086487 / NINDS NIH HHS U01 NS086872 / NINDS NIH HHS U24 NS107220 / NINDS NIH HHS U01 NS092076 / NINDS NIH HHS
- Language
- English
- Date published
- 08/2018
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984020654202771
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