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Identifying Severe Stroke Patients Likely to Benefit From Thrombectomy Despite Delays of up to a Day

Selected patients with large vessel occlusions (LVO) can benefit from thrombectomy up to 24 hours after onset. Identifying patients who might benefit from late intervention after transfer from community hospitals to thrombectomy-capable centers would be valuable. We searched for presentation biomark...

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Autores principales: González, R. Gilberto, Silva, Gisele Sampaio, He, Julian, Sadaghiani, Saloomeh, Wu, Ona, Singhal, Aneesh B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055266/
https://www.ncbi.nlm.nih.gov/pubmed/32132644
http://dx.doi.org/10.1038/s41598-020-60933-3
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author González, R. Gilberto
Silva, Gisele Sampaio
He, Julian
Sadaghiani, Saloomeh
Wu, Ona
Singhal, Aneesh B.
author_facet González, R. Gilberto
Silva, Gisele Sampaio
He, Julian
Sadaghiani, Saloomeh
Wu, Ona
Singhal, Aneesh B.
author_sort González, R. Gilberto
collection PubMed
description Selected patients with large vessel occlusions (LVO) can benefit from thrombectomy up to 24 hours after onset. Identifying patients who might benefit from late intervention after transfer from community hospitals to thrombectomy-capable centers would be valuable. We searched for presentation biomarkers to identify such patients. Frequent MR imaging over 2 days of 38 untreated LVO patients revealed logarithmic growth of the ischemic infarct core. In 24 patients with terminal internal carotid artery or the proximal middle cerebral artery occlusions we found that an infarct core growth rate (IGR) <4.1 ml/hr and initial infarct core volumes (ICV) <19.9 ml had accuracies >89% for identifying patients who would still have a core of <50 ml 24 hours after stroke onset, a core size that should predict favorable outcomes with thrombectomy. Published reports indicate that up to half of all LVO stroke patients have an IGR <4.1 ml/hr. Other potentially useful biomarkers include the NIHSS and the perfusion measurements MTT and Tmax. We conclude that many LVO patients have a stroke physiology that is favorable for late intervention, and that there are biomarkers that can accurately identify them at early time points as suitable for transfer for intervention.
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spelling pubmed-70552662020-03-12 Identifying Severe Stroke Patients Likely to Benefit From Thrombectomy Despite Delays of up to a Day González, R. Gilberto Silva, Gisele Sampaio He, Julian Sadaghiani, Saloomeh Wu, Ona Singhal, Aneesh B. Sci Rep Article Selected patients with large vessel occlusions (LVO) can benefit from thrombectomy up to 24 hours after onset. Identifying patients who might benefit from late intervention after transfer from community hospitals to thrombectomy-capable centers would be valuable. We searched for presentation biomarkers to identify such patients. Frequent MR imaging over 2 days of 38 untreated LVO patients revealed logarithmic growth of the ischemic infarct core. In 24 patients with terminal internal carotid artery or the proximal middle cerebral artery occlusions we found that an infarct core growth rate (IGR) <4.1 ml/hr and initial infarct core volumes (ICV) <19.9 ml had accuracies >89% for identifying patients who would still have a core of <50 ml 24 hours after stroke onset, a core size that should predict favorable outcomes with thrombectomy. Published reports indicate that up to half of all LVO stroke patients have an IGR <4.1 ml/hr. Other potentially useful biomarkers include the NIHSS and the perfusion measurements MTT and Tmax. We conclude that many LVO patients have a stroke physiology that is favorable for late intervention, and that there are biomarkers that can accurately identify them at early time points as suitable for transfer for intervention. Nature Publishing Group UK 2020-03-04 /pmc/articles/PMC7055266/ /pubmed/32132644 http://dx.doi.org/10.1038/s41598-020-60933-3 Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Article
González, R. Gilberto
Silva, Gisele Sampaio
He, Julian
Sadaghiani, Saloomeh
Wu, Ona
Singhal, Aneesh B.
Identifying Severe Stroke Patients Likely to Benefit From Thrombectomy Despite Delays of up to a Day
title Identifying Severe Stroke Patients Likely to Benefit From Thrombectomy Despite Delays of up to a Day
title_full Identifying Severe Stroke Patients Likely to Benefit From Thrombectomy Despite Delays of up to a Day
title_fullStr Identifying Severe Stroke Patients Likely to Benefit From Thrombectomy Despite Delays of up to a Day
title_full_unstemmed Identifying Severe Stroke Patients Likely to Benefit From Thrombectomy Despite Delays of up to a Day
title_short Identifying Severe Stroke Patients Likely to Benefit From Thrombectomy Despite Delays of up to a Day
title_sort identifying severe stroke patients likely to benefit from thrombectomy despite delays of up to a day
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055266/
https://www.ncbi.nlm.nih.gov/pubmed/32132644
http://dx.doi.org/10.1038/s41598-020-60933-3
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