TY - JOUR
T1 - Thrombectomy in stroke of unknown onset, wake up stroke and late presentations
T2 - Australian experience from 2 comprehensive stroke centres
AU - Alsahli, Khalid
AU - Cheung, Andrew K.
AU - Wijesuriya, Nirupama
AU - Cordato, Dennis
AU - Zagami, Alessandro S.
AU - Wenderoth, Jason D.
AU - Chiu, Albert H.
AU - Tay, Kevin
AU - Cappelen-Smith, Cecilia
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Two recent randomized controlled trials (RCTs) showed selected patients treated with endovascular thrombectomy (EVT) more than 6 h from acute ischemic stroke (AIS) onset had significant improvement in functional outcome at 90 days compared with standard care alone. Our aim is to determine the outcome and predictors of good outcome in AIS patients undergoing EVT with unknown-onset, or late presentation, stroke after 6 h from time last seen well, or witnessed stroke onset, at two Australian comprehensive stroke centres. A retrospective analysis of functional outcome and mortality at 90-days from a prospective cohort of 56 consecutive patients with unknown-onset, or late presentation, stroke with large vessel occlusion (LVO) in the anterior cerebral circulation undergoing EVT over a 15-month period (2016–2017). We evaluated factors which correlated with good functional outcome defined as a 90-day modified Rankin scale (mRS) 0–2. Recanalization times and symptomatic intracranial haemorrhage (sICH) rates were also examined. A good functional outcome was achieved in 35 patients (62%). Eight patients died (14%). Median time-to-recanalization was 7.6 h. SICH occurred in four patients (7%). Factors which predicted good 90-day functional outcome included baseline National Institutes of Health Stroke Scale (NIHSS) < 16, 24 h NIHSS < 10, baseline Alberta Stroke Program Early CT Score (ASPECTS) ≥ 8, pre-procedural CT perfusion imaging and LVO lesion location. This study shows good ‘real world’ outcomes, comparable to published RCTs, in patients with unknown-onset, or late presentation, stroke treated with EVT more than 6 h from stroke onset.
AB - Two recent randomized controlled trials (RCTs) showed selected patients treated with endovascular thrombectomy (EVT) more than 6 h from acute ischemic stroke (AIS) onset had significant improvement in functional outcome at 90 days compared with standard care alone. Our aim is to determine the outcome and predictors of good outcome in AIS patients undergoing EVT with unknown-onset, or late presentation, stroke after 6 h from time last seen well, or witnessed stroke onset, at two Australian comprehensive stroke centres. A retrospective analysis of functional outcome and mortality at 90-days from a prospective cohort of 56 consecutive patients with unknown-onset, or late presentation, stroke with large vessel occlusion (LVO) in the anterior cerebral circulation undergoing EVT over a 15-month period (2016–2017). We evaluated factors which correlated with good functional outcome defined as a 90-day modified Rankin scale (mRS) 0–2. Recanalization times and symptomatic intracranial haemorrhage (sICH) rates were also examined. A good functional outcome was achieved in 35 patients (62%). Eight patients died (14%). Median time-to-recanalization was 7.6 h. SICH occurred in four patients (7%). Factors which predicted good 90-day functional outcome included baseline National Institutes of Health Stroke Scale (NIHSS) < 16, 24 h NIHSS < 10, baseline Alberta Stroke Program Early CT Score (ASPECTS) ≥ 8, pre-procedural CT perfusion imaging and LVO lesion location. This study shows good ‘real world’ outcomes, comparable to published RCTs, in patients with unknown-onset, or late presentation, stroke treated with EVT more than 6 h from stroke onset.
KW - Aged
KW - Aged, 80 and over
KW - Australia
KW - Endovascular Procedures/methods
KW - Female
KW - Humans
KW - Middle Aged
KW - Patient Selection
KW - Retrospective Studies
KW - Stroke/surgery
KW - Thrombectomy/methods
KW - Treatment Outcome
UR - http://www.scopus.com/inward/record.url?scp=85055967171&partnerID=8YFLogxK
U2 - 10.1016/j.jocn.2018.10.114
DO - 10.1016/j.jocn.2018.10.114
M3 - Article
C2 - 30414809
SN - 0967-5868
VL - 59
SP - 136
EP - 140
JO - Journal of Clinical Neuroscience
JF - Journal of Clinical Neuroscience
ER -