Journal article
Mechanical thrombectomy beyond 24 hours from last known well in tandem lesions: A multicenter cohort study
Interventional neuroradiology, pp.15910199231196960-15910199231196960
08/29/2023
DOI: 10.1177/15910199231196960
Abstract
Background While recent studies suggest a benefit of mechanical thrombectomy (MT) for the treatment of patients with isolated large vessel occlusions presenting after 24 hours from the last known well (LKW), the effect of MT for acute cervical tandem lesions (TLs) beyond 24 hours remains unknown. We aimed to evaluate the safety and effectiveness of MT beyond 24 hours of LKW in patients with TLs. Methods We conducted a subanalysis study of patients with anterior circulation TL enrolled in a large, multicenter registry between January 2015 and December 2020. Patients were divided into 2 groups: MT beyond 24 hours versus MT 0–24-hour window. Outcomes of interest were functional independence (90-day modified Rankin scale 0-2), complete reperfusion (modified thrombolysis in cerebral infarction 3), delta NIH Stroke Scale (NIHSS), symptomatic intracranial hemorrhage (sICH), parenchymal hematoma 2 (PH2), in-hospital mortality, and 90-day mortality. Inverse probability of treatment weighting (IPTW) was used to balance the groups. Results Overall, 589 participants were included, with 33 treated beyond 24 hours and 556 treated in the 0–24-hour window. After IPTW, we found no significant difference in the rates of achieving functional independence (odds ratio (OR) = 0.51; 95% confidence interval (CI) 0.22–1.16; p = 0.108), complete reperfusion (OR = 1.35; 95% CI 0.60–3.05; p = 0.464), sICH (OR = 1.96; 95% CI 0.37–10.5; p = 0.429), delta NIHSS (β = −3.61; 95% CI −8.11 to 0.87; p = 0.114), PH2 (OR = 1.46; 95% CI 0.29–7.27; p = 0.642), in-hospital mortality (OR = 1.74; 95% CI 0.52–5.86; p = 0.370), or 90-day mortality (OR = 1.37; 95% CI 0.49–3.83; p = 0.544) across both time windows. Conclusions Our results suggest that MT appears to benefit patients with TLs beyond 24 hours from LKW. Future prospective studies are warranted.
Details
- Title: Subtitle
- Mechanical thrombectomy beyond 24 hours from last known well in tandem lesions: A multicenter cohort study
- Creators
- Aaron Rodriguez-Calienes - University of IowaAmeer E Hassan - Valley Baptist Medical CenterJames E Siegler - Cooper University HospitalMilagros Galecio-Castillo - University of IowaMudassir Farooqui - University of IowaMouhammad A Jumaa - ProMedica Toledo HospitalNazli Janjua - Pomona Valley Hospital Medical CenterAfshin A Divani - University of New MexicoMarc Ribo - Vall d'Hebron Hospital UniversitariMichael Abraham - University of Kansas Medical CenterNils H Petersen - Yale UniversityJohanna Fifi - Icahn School of Medicine at Mount SinaiWaldo R Guerrero - University of South FloridaAmer M Malik - University of MiamiThanh N Nguyen - Boston Medical CenterSunil Sheth - The University of Texas Health Science CenterAlbert J YooGuillermo Linares - Saint Louis UniversityYujing Lu - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USAJuan Vivanco-Suarez - University of Iowa Hospitals and ClinicsSantiago Ortega-Gutierrez - University of Iowa Hospitals and Clinics
- Resource Type
- Journal article
- Publication Details
- Interventional neuroradiology, pp.15910199231196960-15910199231196960
- DOI
- 10.1177/15910199231196960
- ISSN
- 1591-0199
- eISSN
- 2385-2011
- Language
- English
- Electronic publication date
- 08/29/2023
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984459415302771
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