Journal article
Reperfusion Without Functional Independence in Late Presentation of Stroke With Large Vessel Occlusion
Stroke (1970), Vol.53(12), pp.3594-3604
10/14/2022
DOI: 10.1161/STROKEAHA.122.039476
PMID: 36252092
Abstract
BACKGROUND Reperfusion without functional independence (RFI) is an undesired outcome following thrombectomy in acute ischemic stroke. The primary objective was to evaluate, in patients presenting with proximal anterior circulation occlusion stroke in the extended time window, whether selection with computed tomography (CT) perfusion or magnetic resonance imaging is associated with RFI, mortality, or symptomatic intracranial hemorrhage (sICH) compared with noncontrast CT selected patients. METHODS The CLEAR study (CT for Late Endovascular Reperfusion) was a multicenter, retrospective cohort study of stroke patients undergoing thrombectomy in the extended time window. Inclusion criteria for this analysis were baseline National Institutes of Health Stroke Scale score ≥6, internal carotid artery, M1 or M2 segment occlusion, prestroke modified Rankin Scale score of 0 to 2, time-last-seen-well to treatment 6 to 24 hours, and successful reperfusion (modified Thrombolysis in Cerebral Infarction 2c-3). RESULTS Of 2304 patients in the CLEAR study, 715 patients met inclusion criteria. Of these, 364 patients (50.9%) showed RFI (ie, mRS score of 3-6 at 90 days despite successful reperfusion), 37 patients (5.2%) suffered sICH, and 127 patients (17.8%) died within 90 days. Neither imaging selection modality for thrombectomy candidacy (noncontrast CT versus CT perfusion versus magnetic resonance imaging) was associated with RFI, sICH, or mortality. Older age, higher baseline National Institutes of Health Stroke Scale, higher prestroke disability, transfer to a comprehensive stroke center, and a longer interval to puncture were associated with RFI. The presence of M2 occlusion and higher baseline Alberta Stroke Program Early CT Score were inversely associated with RFI. Hypertension was associated with sICH. CONCLUSIONSRFI is a frequent phenomenon in the extended time window. Neither magnetic resonance imaging nor CT perfusion selection for mechanical thrombectomy was associated with RFI, sICH, and mortality compared to noncontrast CT selection alone. REGISTRATION URL: https://www. CLINICALTRIALSgov; Unique identifier: NCT04096248.
Details
- Title: Subtitle
- Reperfusion Without Functional Independence in Late Presentation of Stroke With Large Vessel Occlusion
- Creators
- Fatih Seker - University Hospital HeidelbergMuhammad M Qureshi - Boston Medical CenterMarkus A Möhlenbruch - University Hospital HeidelbergRaul G Nogueira - University of Pittsburgh Medical CenterMohamad Abdalkader - Boston Medical CenterMarc Ribo - Vall d'Hebron Hospital UniversitariFrancois Caparros - University of LilleDiogo C Haussen - Grady Memorial HospitalMahmoud H Mohammaden - Grady Memorial HospitalSunil A Sheth - The University of Texas Health Science Center at HoustonSantiago Ortega-Gutierrez - University of IowaJames E Siegler - Cooper Neurological Institute, Cherry Hill, NJ (J.E.S., A.R., T.G.J.).Syed F Zaidi - University of ToledoMarta Olive-Gadea - Vall d'Hebron Hospital UniversitariHilde Henon - University of LilleAlicia C Castonguay - University of ToledoStefania Nannoni - University of LausanneJohannes Kaesmacher - University Hospital of BernAjit S Puri - University of Massachusetts Medical SchoolMudassir Farooqui - University of IowaSergio Salazar-Marioni - Neurology, UTHealth McGovern Medical School, Houston, TX (S.A.S., S.S.-M.).Anna L Kuhn - University of Massachusetts Medical SchoolNicole L Kiley - Boston Medical CenterBehzad Farzin - Centre Hospitalier de l’Université de MontréalWilliam Boisseau - Centre Hospitalier de l’Université de MontréalHesham E Masoud - SUNY Upstate Medical UniversityCarlos Ynigo Lopez - SUNY Upstate Medical UniversityAmeena Rana - Cooper Neurological Institute, Cherry Hill, NJ (J.E.S., A.R., T.G.J.).Samer Abdul KareemAnvitha Sathya - Boston Medical CenterPiers Klein - Boston Medical CenterMohammad W Kassem - Bon Secours Mercy HealthCharlotte Cordonnier - University of LilleJan Gralla - University Hospital of BernUrs Fischer - University Hospital of BernPatrik Michel - University of LausanneDavide Strambo - University of LausanneTudor G JovinJean Raymond - Centre Hospitalier de l’Université de MontréalOsama O Zaidat - Bon Secours Mercy HealthPeter A Ringleb - University Hospital HeidelbergThanh N Nguyen - Boston Medical CenterSimon Nagel - University Hospital Heidelberg
- Resource Type
- Journal article
- Publication Details
- Stroke (1970), Vol.53(12), pp.3594-3604
- DOI
- 10.1161/STROKEAHA.122.039476
- PMID
- 36252092
- NLM abbreviation
- Stroke
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Language
- English
- Date published
- 10/14/2022
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984306360102771
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