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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...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Nature Publishing Group UK
2020
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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. |
format | Online Article Text |
id | pubmed-7055266 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Nature Publishing Group UK |
record_format | MEDLINE/PubMed |
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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