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Extended Window for Stroke Thrombectomy
OBJECTIVE: Mechanical thrombectomy is the standard treatment for large vessel occlusion (LVO) in acute ischemic stroke (AIS) up to 6 h after onset. Recent trials have demonstrated a benefit for wake-up strokes and patients beyond 6 h. METHODS: A systematic literature review was conducted for multice...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer - Medknow
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454953/ https://www.ncbi.nlm.nih.gov/pubmed/31001020 http://dx.doi.org/10.4103/jnrp.jnrp_365_18 |
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author | Snelling, Brian Mccarthy, David J. Chen, Stephanie Sur, Samir Elwardany, Omar Sheinberg, Dallas L. Yavagal, Dileep R. Peterson, Eric C. Starke, Robert M. |
author_facet | Snelling, Brian Mccarthy, David J. Chen, Stephanie Sur, Samir Elwardany, Omar Sheinberg, Dallas L. Yavagal, Dileep R. Peterson, Eric C. Starke, Robert M. |
author_sort | Snelling, Brian |
collection | PubMed |
description | OBJECTIVE: Mechanical thrombectomy is the standard treatment for large vessel occlusion (LVO) in acute ischemic stroke (AIS) up to 6 h after onset. Recent trials have demonstrated a benefit for wake-up strokes and patients beyond 6 h. METHODS: A systematic literature review was conducted for multicenter randomized clinical trials (RCTs) investigating endovascular stroke treatment using perfusion imaging to identify patients that may benefit from mechanical thrombectomy for AIS beyond 6 h of onset. Random effects meta-analysis was used to analyze the following outcomes: 90-day functional independence rates with modified Rankin Scale (mRS ≤2), 90-day mortality, and symptomatic intracranial hemorrhage (sICH) rates. Further stratification was carried out by age and presentation. RESULTS: Two multicenter RCT's were included as follows: DAWN and DEFUSE-3. Pooled 90-day functional independence rates favored endovascular management (odds ratio [OR] 5.01; P < 0.00001). Subgroup analysis demonstrated continued 90-day functional independence benefit for endovascular management regardless of age (≥80 years, OR 5.65, P = 0.01; ≤80 years, OR 4.92, P < 0.00001). When stratified for the manner of stroke discovery, 90-day functional independence rates favored endovascular management for wake-up strokes (OR 8.74, P < 0.00001) and known-time onset strokes (OR 5.08, 95% confidence interval [CI] 2.04–12.65, P = 0.0005), although no benefit was observed for unwitnessed strokes (OR 1.64, 95% CI 0.17–16.04, P = 0.67). No difference observed in 90-day mortality rates (OR 0.71; P = 0.14) or in SICH rates (OR 1.67; P = 0.29). CONCLUSIONS: This meta-analysis reinforces that endovascular management is superior to standard medical management alone for the treatment of AIS due to LVO beyond 6 h of onset in patients with perfusion-imaging selection. |
format | Online Article Text |
id | pubmed-6454953 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Wolters Kluwer - Medknow |
record_format | MEDLINE/PubMed |
spelling | pubmed-64549532019-04-18 Extended Window for Stroke Thrombectomy Snelling, Brian Mccarthy, David J. Chen, Stephanie Sur, Samir Elwardany, Omar Sheinberg, Dallas L. Yavagal, Dileep R. Peterson, Eric C. Starke, Robert M. J Neurosci Rural Pract Original Article OBJECTIVE: Mechanical thrombectomy is the standard treatment for large vessel occlusion (LVO) in acute ischemic stroke (AIS) up to 6 h after onset. Recent trials have demonstrated a benefit for wake-up strokes and patients beyond 6 h. METHODS: A systematic literature review was conducted for multicenter randomized clinical trials (RCTs) investigating endovascular stroke treatment using perfusion imaging to identify patients that may benefit from mechanical thrombectomy for AIS beyond 6 h of onset. Random effects meta-analysis was used to analyze the following outcomes: 90-day functional independence rates with modified Rankin Scale (mRS ≤2), 90-day mortality, and symptomatic intracranial hemorrhage (sICH) rates. Further stratification was carried out by age and presentation. RESULTS: Two multicenter RCT's were included as follows: DAWN and DEFUSE-3. Pooled 90-day functional independence rates favored endovascular management (odds ratio [OR] 5.01; P < 0.00001). Subgroup analysis demonstrated continued 90-day functional independence benefit for endovascular management regardless of age (≥80 years, OR 5.65, P = 0.01; ≤80 years, OR 4.92, P < 0.00001). When stratified for the manner of stroke discovery, 90-day functional independence rates favored endovascular management for wake-up strokes (OR 8.74, P < 0.00001) and known-time onset strokes (OR 5.08, 95% confidence interval [CI] 2.04–12.65, P = 0.0005), although no benefit was observed for unwitnessed strokes (OR 1.64, 95% CI 0.17–16.04, P = 0.67). No difference observed in 90-day mortality rates (OR 0.71; P = 0.14) or in SICH rates (OR 1.67; P = 0.29). CONCLUSIONS: This meta-analysis reinforces that endovascular management is superior to standard medical management alone for the treatment of AIS due to LVO beyond 6 h of onset in patients with perfusion-imaging selection. Wolters Kluwer - Medknow 2019 /pmc/articles/PMC6454953/ /pubmed/31001020 http://dx.doi.org/10.4103/jnrp.jnrp_365_18 Text en Copyright: © 2019 Journal of Neurosciences in Rural Practice http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Snelling, Brian Mccarthy, David J. Chen, Stephanie Sur, Samir Elwardany, Omar Sheinberg, Dallas L. Yavagal, Dileep R. Peterson, Eric C. Starke, Robert M. Extended Window for Stroke Thrombectomy |
title | Extended Window for Stroke Thrombectomy |
title_full | Extended Window for Stroke Thrombectomy |
title_fullStr | Extended Window for Stroke Thrombectomy |
title_full_unstemmed | Extended Window for Stroke Thrombectomy |
title_short | Extended Window for Stroke Thrombectomy |
title_sort | extended window for stroke thrombectomy |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454953/ https://www.ncbi.nlm.nih.gov/pubmed/31001020 http://dx.doi.org/10.4103/jnrp.jnrp_365_18 |
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